| No: B-348 | Date: 18/10/2025 | ||
| Patient Name: DIRG PRAKASHBHAI MODI | |||
| Age: 5.5Y | M/F: MALE | ||
| Address:- PATAN | |||
| D.O.A.: 15/10/2025 | D.O.D.: 18/10/2025 | ||
| Diagnosis: SEPTICEMIA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL | 4800.00 | ||
| IN WORDS : FOUR THOUSAND, EIGHT HUNDRED RUPEES ONLY | |||
| Signature | |||