| No: B-455 | Date: 31/12/2025 | ||
| Patient Name: SHADDHA NILESH PATEL | |||
| Age: 27M | M/F: FEMALE | ||
| Address:- ADIYA | |||
| D.O.A.: 26/12/2025 | D.O.D.: 31/12/2025 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 6 | 2,500.00 | 15,000.00 |
| TOTAL | 15000.00 | ||
| IN WORDS : FIFTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||