| No: B-480 | Date: 13/01/2026 | ||
| Patient Name: JIYANSHI VISHNUBHAI PATANI | |||
| Age: 5Y | M/F: FEMALE | ||
| Address:- PATAN | |||
| D.O.A.: 07/01/2026 | D.O.D.: 13/01/2026 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 7 | 1,500.00 | 10,500.00 |
| TOTAL | 10500.00 | ||
| IN WORDS : TEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||