| No: B-349 | Date: 21/10/2025 | ||
| Patient Name: MISHA DHAVAL PANCHAL | |||
| Age: 9Y | M/F: FEMALE | ||
| Address:- RADHANPUR | |||
| D.O.A.: 17/10/2025 | D.O.D.: 21/10/2025 | ||
| Diagnosis: SEPTICEMIA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL | 5000.00 | ||
| IN WORDS : FIVE THOUSAND RUPEES ONLY | |||
| Signature | |||