Ticket for Outdoor Patient
| Ward No. 5 | U-PHC No. | Registration No. 01991 | Date 26/04/2019 |
| Token No | SM/18-19/3424 26/04/2019 | Serial | 020 |
| Patient Name | Miss AISHA KHATUN | Contact No | 8420858665 |
| Address | 16 K.M. SHA ST | Age | 6 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||