Ticket for Outdoor Patient
| Ward No. 14 | U-PHC No. | Registration No. 01659 | Date 14/02/2019 |
| Token No | SM/18-19/2445 14/02/2019 | Serial | 011 |
| Patient Name | Miss NAZIMA KHATUN | Contact No | NOT GIVEN |
| Address | 84 DEY STREET | Age | 20 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||