| No: B-107 | Date: 26/05/2025 | ||
| Patient Name: AYUSH NIKULBHAI SUTHAR | |||
| Age: 3YRS | M/F: MALE | ||
| Address:- BOLERA | |||
| D.O.A.: 23/05/2025 | D.O.D.: 26/05/2025 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,500.00 | 14,000.00 |
| TOTAL | 14000.00 | ||
| IN WORDS : FOURTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||