Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05330 | Date 03/06/2019 |
| Token No | SM/19-20/3945 03/06/2019 | Serial | 068 Last Visit: 03/06/2019 |
| Patient Name | Miss SABANA KHATUN | Contact No | 9073429385 |
| Address | 9 ARBINDA SARANI CHATRA MUSALMAN PARA | Age | 12 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 28 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||