Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05280 | Date 29/05/2019 |
| Token No | SM/19-20/3653 29/05/2019 | Serial | 020 Last Visit: 29/05/2019 |
| Patient Name | Mr. HASAN RAHAMAN | Contact No | 9051217654 |
| Address | 17/2/A/2 MUSALMAN PARA BYE LANE CHATRA | Age | 15 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 69 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||