| No: B-176 | Date: 18/07/2025 | ||
| Patient Name: SOURYA ISWERBHAI DESAI | |||
| Age: 6M | M/F: MALE | ||
| Address:- UN | |||
| D.O.A.: 16/07/2025 | D.O.D.: 18/07/2025 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 2,900.00 | 8,700.00 |
| TOTAL | 8700.00 | ||
| IN WORDS : EIGHT THOUSAND, SEVEN HUNDRED RUPEES ONLY | |||
| Signature | |||