Ticket for Outdoor Patient
| Ward No. 1 | U-PHC No. | Registration No. 16202 | Date 25/10/2025 |
| Token No | SM/25-26/7299 25/10/2025 | Serial | 005 Last Visit: 11/12/2025 |
| Patient Name | Mrs. TABASUM KHATUN | Contact No | |
| Address | CHATRA MUSALMAN PARA ROAD | Age | 22 Years,2 Months,9 Days Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm BMI: nan |
| Diagnosis | |||