Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03052 | Date 17/01/2019 |
| Token No | SM/19-20/11987 18/10/2019 | Serial | 007 Last Visit: 14/01/2020 |
| Patient Name | Mr. SAMIULLA LASKAR | Contact No | 8926679534 |
| Address | 18, CHATRA MUSALMAN PARA | Age | 14 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 55 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||