Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 00554 | Date 18/08/2018 |
| Token No | SM/20-21/29344 14/01/2021 | Serial | 010 Last Visit: 14/01/2021 |
| Patient Name | Mr. SK. SAMSUDIN | Contact No | 8820186193 |
| Address | 18 CHATRA MUSALMAN PARA BYE LANE | Age | 18 YRS Male |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||