Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02691 | Date 01/08/2019 |
| Token No | SM/18-19/5336 01/08/2019 | Serial | 027 |
| Patient Name | Mrs. MOSLEMA KHATUN | Contact No | 9883073752 |
| Address | 51/A DEY STREET | Age | 52 YRS Female |
| Token For | Medicine, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||