| No: B-450 | Date: 26/12/2025 | ||
| Patient Name: DIPAK PRAKASH JOSHI | |||
| Age: 5M | M/F: MALE | ||
| Address:- SIRWADA | |||
| D.O.A.: 23/12/2025 | D.O.D.: 26/12/2025 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 2,500.00 | 10,000.00 |
| TOTAL | 10000.00 | ||
| IN WORDS : TEN THOUSAND RUPEES ONLY | |||
| Signature | |||