| No: B-21 | Date: 11/04/2025 | ||
| Patient Name: PRINCE VIJAYBHAI CHAUDHARI | |||
| Age: 2YRS | M/F: MALE | ||
| Address:- JALMOR | |||
| D.O.A.: 08/04/2025 | D.O.D.: 11/04/2025 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 4,250.00 | 17,000.00 |
| TOTAL | 17000.00 | ||
| IN WORDS : SEVENTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||