| No: B-230 | Date: 11/08/2025 | ||
| Patient Name: AHAMAD ARIF KHORAJIYA | |||
| Age: 9M | M/F: MALE | ||
| Address:- ABLUVA | |||
| D.O.A.: 07/08/2025 | D.O.D.: 11/08/2025 | ||
| Diagnosis: FEVER | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 1,500.00 | 7,500.00 |
| TOTAL | 7500.00 | ||
| IN WORDS : SEVEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||