| No: B-347 | Date: 16/10/2025 | ||
| Patient Name: VEER BHARATBHAI DARJI | |||
| Age: 22M | M/F: MALE | ||
| Address:- DEODAR | |||
| D.O.A.: 14/10/2025 | D.O.D.: 16/10/2025 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 5,000.00 | 15,000.00 |
| TOTAL | 15000.00 | ||
| IN WORDS : FIFTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||