| No: B-430 | Date: 15/12/2025 | ||
| Patient Name: BHAVYA BALDEV GOSWAMI | |||
| Age: 7Y | M/F: MALE | ||
| Address:- RADHANPUR | |||
| D.O.A.: 12/12/2025 | D.O.D.: 15/12/2025 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 2,000.00 | 8,000.00 |
| TOTAL | 8000.00 | ||
| IN WORDS : EIGHT THOUSAND RUPEES ONLY | |||
| Signature | |||