| No: B-364 | Date: 13/11/2025 | ||
| Patient Name: BABY VIRAM THAKOR | |||
| Age: 4D | M/F: FEMALE | ||
| Address:- DEHGAM | |||
| D.O.A.: 31/10/2025 | D.O.D.: 13/11/2025 | ||
| Diagnosis: SEPTICEMIA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL | 14000.00 | ||
| IN WORDS : FOURTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||