| No: B-145 | Date: 30/06/2025 | ||
| Patient Name: BHAILU DHRUMIL DESAI | |||
| Age: 7M | M/F: MALE | ||
| Address:- SODHAV | |||
| D.O.A.: 28/06/2025 | D.O.D.: 30/06/2025 | ||
| Diagnosis: SKIN DECEASE | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 4,500.00 | 13,500.00 |
| TOTAL | 13500.00 | ||
| IN WORDS : THIRTEEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||