Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02138 | Date 28/05/2019 |
| Token No | SM/18-19/3846 28/05/2019 | Serial | 020 |
| Patient Name | Mrs. TABASSUM KHATUN | Contact No | NOT GIVEN |
| Address | DEY ST | Age | 25 Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||