| No: B-321 | Date: 04/10/2025 | ||
| Patient Name: DHRITI H. MODI | |||
| Age: 9Y | M/F: FEMALE | ||
| Address:- PATAN | |||
| D.O.A.: 29/09/2025 | D.O.D.: 04/10/2025 | ||
| Diagnosis: VIRAL HEPATITIS WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 6 | 3,000.00 | 18,000.00 |
| TOTAL | 18000.00 | ||
| IN WORDS : EIGHTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||