Ticket for Outdoor Patient
| Ward No. 7 | U-PHC No. | Registration No. 05188 | Date 21/05/2019 |
| Token No | SM/19-20/3159 21/05/2019 | Serial | 107 Last Visit: 21/05/2019 |
| Patient Name | Miss SAMISA SULTANA | Contact No | 8100962447 |
| Address | 21 TIKIYA PARA, | Age | 12 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 45 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||