| No: B-461 | Date: 31/12/2025 | ||
| Patient Name: VIPUL CHANDAN THAKOR | |||
| Age: 1.3Y | M/F: MALE | ||
| Address:- DHUVA | |||
| D.O.A.: 28/12/2025 | D.O.D.: 31/12/2025 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,000.00 | 12,000.00 |
| TOTAL | 12000.00 | ||
| IN WORDS : TWELVE THOUSAND RUPEES ONLY | |||
| Signature | |||