| No: B-203 | Date: 29/07/2025 | ||
| Patient Name: HIYAN VIKRAM PATEL | |||
| Age: 5Y | M/F: MALE | ||
| Address:- NORTA | |||
| D.O.A.: 26/07/2025 | D.O.D.: 29/07/2025 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 1,200.00 | 3,600.00 |
| TOTAL | 3600.00 | ||
| IN WORDS : THREE THOUSAND, SIX HUNDRED RUPEES ONLY | |||
| Signature | |||