Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 04034 | Date 06/03/2019 |
| Token No | SM/19-20/8774 20/08/2019 | Serial | 053 Last Visit: 15/11/2019 |
| Patient Name | Miss SABANA KHATUN | Contact No | 9051339807 |
| Address | 17 CHATRA KUMOR PARA /LANE | Age | 14 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | 51 KG |
| Pulse Rate | / min | Height | cm BMI: inf |
| Diagnosis | |||