Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05203 | Date 22/05/2019 |
| Token No | SM/19-20/3249 22/05/2019 | Serial | 090 Last Visit: 22/05/2019 |
| Patient Name | Mr. MUSTAK HOSSAIN | Contact No | |
| Address | 21 CHATRA KUMAR BYE LANE | Age | 7 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 15 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||