| No: B-19 | Date: 07/04/2025 | ||
| Patient Name: JAYRA SHAILESHBHAI RABARI | |||
| Age: 3YRS | M/F: MALE | ||
| Address:- RUVAVI | |||
| D.O.A.: 07/04/2025 | D.O.D.: 07/04/2025 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 2,800.00 | 8,400.00 |
| TOTAL | 8400.00 | ||
| IN WORDS : EIGHT THOUSAND, FOUR HUNDRED RUPEES ONLY | |||
| Signature | |||