| No: B-269 | Date: 31/08/2025 | ||
| Patient Name: BABO VINUJI THAKOR | |||
| Age: 3M | M/F: MALE | ||
| Address:- MESAR | |||
| D.O.A.: 28/08/2025 | D.O.D.: 31/08/2025 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 1,000.00 | 3,000.00 |
| TOTAL | 3000.00 | ||
| IN WORDS : THREE THOUSAND RUPEES ONLY | |||
| Signature | |||