| No: B-162 | Date: 10/07/2025 | ||
| Patient Name: AYUSH ASHOKJI THAKOR | |||
| Age: 4M | M/F: MALE | ||
| Address:- RODA | |||
| D.O.A.: 07/07/2025 | D.O.D.: 10/07/2025 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,900.00 | 15,600.00 |
| TOTAL | 15600.00 | ||
| IN WORDS : FIFTEEN THOUSAND, SIX HUNDRED RUPEES ONLY | |||
| Signature | |||