Ticket for Outdoor Patient
| Ward No. | U-PHC No. | Registration No. 00044 | Date 03/08/2018 |
| Token No | SM/18-19/44 03/08/2018 | Serial | 025 |
| Patient Name | Miss CHANDNI KHATUN | Contact No | |
| Address | Age | 17 Female | |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||