| No: B-39 | Date: 16/04/2025 | ||
| Patient Name: FATEMA IMRAN MUMAN | |||
| Age: 3YRS | M/F: FEMALE | ||
| Address:- RADHANPUR | |||
| D.O.A.: 12/04/2025 | D.O.D.: 16/04/2025 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 2,750.00 | 11,000.00 |
| TOTAL | 11000.00 | ||
| IN WORDS : ELEVEN THOUSAND RUPEES ONLY | |||
| Signature | |||