| No: B-263 | Date: 27/08/2025 | ||
| Patient Name: BHAGYA NARENDRA NAYAK | |||
| Age: 5Y | M/F: MALE | ||
| Address:- VARVADA | |||
| D.O.A.: 23/08/2025 | D.O.D.: 27/08/2025 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 1,000.00 | 4,000.00 |
| TOTAL | 4000.00 | ||
| IN WORDS : FOUR THOUSAND RUPEES ONLY | |||
| Signature | |||