| No: B-175 | Date: 18/07/2025 | ||
| Patient Name: JAINALI NIKESH PATEL | |||
| Age: 7Y | M/F: FEMALE | ||
| Address:- PATAN | |||
| D.O.A.: 15/07/2025 | D.O.D.: 18/07/2025 | ||
| Diagnosis: VIRAL HEPATITIS WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 2,900.00 | 11,600.00 |
| TOTAL | 11600.00 | ||
| IN WORDS : ELEVEN THOUSAND, SIX HUNDRED RUPEES ONLY | |||
| Signature | |||