Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 03671 | Date 18/02/2019 |
| Token No | SM/20-21/26727 16/10/2020 | Serial | 004 Last Visit: 16/10/2020 |
| Patient Name | Miss ASMA KHATUN | Contact No | 7059904137 |
| Address | 5/A CHATRA MUSALMAN PARA | Age | 15 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||