| No: B-111 | Date: 26/05/2025 | ||
| Patient Name: DARSHITABA ROHITSINH RAJPUT | |||
| Age: 4YRS | M/F: FEMALE | ||
| Address:- BANASANA | |||
| D.O.A.: 24/05/2025 | D.O.D.: 26/05/2025 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 2,500.00 | 12,500.00 |
| TOTAL | 12500.00 | ||
| IN WORDS : TWELVE THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||