| No: B-319 | Date: 30/09/2025 | ||
| Patient Name: SHMIT D. CHAUDHARI | |||
| Age: 9Y | M/F: FEMALE | ||
| Address:- NASRATPURA | |||
| D.O.A.: 27/09/2025 | D.O.D.: 30/09/2025 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 1,500.00 | 6,000.00 |
| TOTAL | 6000.00 | ||
| IN WORDS : SIX THOUSAND RUPEES ONLY | |||
| Signature | |||