Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 05377 | Date 10/06/2019 |
| Token No | SM/19-20/4310 10/06/2019 | Serial | 092 Last Visit: 10/06/2019 |
| Patient Name | Baby TAMANA KHATUN | Contact No | 8101002766 |
| Address | CHATRA MUSALMAN PARA | Age | 3 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||