Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 02360 | Date 05/12/2018 |
| Token No | SM/21-22/3800 05/08/2021 | Serial | 032 Last Visit: 04/06/2022 |
| Patient Name | Baby JHUMPA KHATUN | Contact No | |
| Address | 18/1 CHATRA MUSALMAN PARA | Age | 4 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||