| No: B-375 | Date: 11/11/2025 | ||
| Patient Name: SIDDHA VIKRAM DESAI | |||
| Age: 3Y | M/F: MALE | ||
| Address:- DEVPURA | |||
| D.O.A.: 08/11/2025 | D.O.D.: 11/11/2025 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL | 4800.00 | ||
| IN WORDS : FOUR THOUSAND, EIGHT HUNDRED RUPEES ONLY | |||
| Signature | |||