| No: B-181 | Date: 20/07/2025 | ||
| Patient Name: JAYRAJ JAYDEEP ZALA | |||
| Age: 7Y | M/F: MALE | ||
| Address:- VIRAMGAM | |||
| D.O.A.: 17/07/2025 | D.O.D.: 20/07/2025 | ||
| Diagnosis: FEVER WITH CHIKANGUNIYA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,600.00 | 14,400.00 |
| TOTAL | 14400.00 | ||
| IN WORDS : FOURTEEN THOUSAND, FOUR HUNDRED RUPEES ONLY | |||
| Signature | |||