| No: B-250 | Date: 20/08/2025 | ||
| Patient Name: SANDIP JITENDRA THAKOR | |||
| Age: 4Y | M/F: MALE | ||
| Address:- MESAR | |||
| D.O.A.: 15/08/2025 | D.O.D.: 20/08/2025 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| 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 | |||