| No: B-271 | Date: 28/08/2025 | ||
| Patient Name: KISMAT MUKESH THAKOR | |||
| Age: 6Y | M/F: MALE | ||
| Address:- RANAWADA | |||
| D.O.A.: 28/08/2025 | D.O.D.: 28/08/2025 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 1 | 1,000.00 | 1,000.00 |
| TOTAL | 1000.00 | ||
| IN WORDS : ONE THOUSAND RUPEES ONLY | |||
| Signature | |||