| No: B-142 | Date: 28/06/2025 | ||
| Patient Name: KANO JAKTABHAI RABARI | |||
| Age: 13M | M/F: MALE | ||
| Address:- FULPURA | |||
| D.O.A.: 25/06/2025 | D.O.D.: 28/06/2025 | ||
| Diagnosis: MESENTERIC ADENITIS WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 4,000.00 | 12,000.00 |
| TOTAL | 12000.00 | ||
| IN WORDS : TWELVE THOUSAND RUPEES ONLY | |||
| Signature | |||