| No: B-429 | Date: 21/12/2025 | ||
| Patient Name: VEDANSHI VINOD RAVAL | |||
| Age: 1M | M/F: FEMALE | ||
| Address:- SHIHORI | |||
| D.O.A.: 11/12/2025 | D.O.D.: 21/12/2025 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 10 | 1,500.00 | 15,000.00 |
| TOTAL | 15000.00 | ||
| IN WORDS : FIFTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||