Ticket for Outdoor Patient
| Ward No. 12 | U-PHC No. | Registration No. 02144 | Date 30/05/2019 |
| Token No | SM/22-23/4224 01/08/2022 | Serial | 012 |
| Patient Name | Miss MONOHARA KHATUN | Contact No | NOT GIVEN |
| Address | dey street | Age | 14 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||