| No: B-472 | Date: 04/01/2026 | ||
| Patient Name: ARUNABA MAHENDRA ZALA | |||
| Age: 3Y | M/F: FEMALE | ||
| Address:- VADLOD | |||
| D.O.A.: 02/01/2026 | D.O.D.: 04/01/2026 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 2,000.00 | 6,000.00 |
| TOTAL | 6000.00 | ||
| IN WORDS : SIX THOUSAND RUPEES ONLY | |||
| Signature | |||