Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 02627 | Date 21/12/2018 |
| Token No | SM/19-20/14583 03/12/2019 | Serial | 066 Last Visit: 03/12/2019 |
| Patient Name | Miss KORISIN HOSNA | Contact No | 9007274830 |
| Address | CHATRA BOUBAZAR | Age | 7 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 18 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||