| No: B-396 | Date: 25/11/2025 | ||
| Patient Name: RAVAL HIRAL AMRATBHAI | |||
| Age: 12Y | M/F: FEMALE | ||
| Address:- RANER | |||
| D.O.A.: 24/11/2025 | D.O.D.: 25/11/2025 | ||
| Diagnosis: DIABETES TRETMENT | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL | 4000.00 | ||
| IN WORDS : FOUR THOUSAND RUPEES ONLY | |||
| Signature | |||