| No: B-248 | Date: 16/08/2025 | ||
| Patient Name: SHIDDHI SANJAY PATANI | |||
| Age: 22M | M/F: FEMALE | ||
| Address:- PATAN | |||
| D.O.A.: 14/08/2025 | D.O.D.: 16/08/2025 | ||
| Diagnosis: PNUEMONIA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 2 | 2,500.00 | 5,000.00 |
| TOTAL | 5000.00 | ||
| IN WORDS : FIVE THOUSAND RUPEES ONLY | |||
| Signature | |||