| No: B-125 | Date: 10/06/2025 | ||
| Patient Name: BABO PRAKASHBHAI THAKOR | |||
| Age: 1M | M/F: MALE | ||
| Address:- VADHI | |||
| D.O.A.: 07/06/2025 | D.O.D.: 10/06/2025 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 500.00 | 2,000.00 |
| TOTAL | 2000.00 | ||
| IN WORDS : TWO THOUSAND RUPEES ONLY | |||
| Signature | |||