| No: B-22 | Date: 12/04/2025 | ||
| Patient Name: SIFA MOHAMAD PATHAN | |||
| Age: 8MONTHS | M/F: FEMALE | ||
| Address:- SHIDDHPUR | |||
| D.O.A.: 08/04/2025 | D.O.D.: 12/04/2025 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 900.00 | 4,500.00 |
| TOTAL | 4500.00 | ||
| IN WORDS : FOUR THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||