| No: B-154 | Date: 07/07/2025 | ||
| Patient Name: DHARMIK ASHVINBHAI MALI | |||
| Age: 1.5Y | M/F: MALE | ||
| Address:- NATHPURA | |||
| D.O.A.: 03/07/2025 | D.O.D.: 07/07/2025 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| 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 | |||