| No: B-251 | Date: 18/08/2025 | ||
| Patient Name: SHAKTISINH PRAVIN VAGHELA | |||
| Age: 13M | M/F: MALE | ||
| Address:- KHARIYA | |||
| D.O.A.: 16/08/2025 | D.O.D.: 18/08/2025 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 2,000.00 | 6,000.00 |
| TOTAL | 6000.00 | ||
| IN WORDS : SIX THOUSAND RUPEES ONLY | |||
| Signature | |||