Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02179 | Date 28/11/2018 |
| Token No | SM/19-20/6604 16/07/2019 | Serial | 052 Last Visit: 16/07/2019 |
| Patient Name | Miss ROOKSANA KHATUN | Contact No | 9239868147 |
| Address | 20 CHATRA KUMOR PARA LANE | Age | 15 Y Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 40 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||