| No: B-483 | Date: 14/01/2026 | ||
| Patient Name: KULDEEP PRAHLADBHAI ZALA | |||
| Age: 6Y | M/F: MALE | ||
| Address:- PATAN | |||
| D.O.A.: 09/01/2026 | D.O.D.: 14/01/2026 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 6 | 1,500.00 | 9,000.00 |
| TOTAL | 9000.00 | ||
| IN WORDS : NINE THOUSAND RUPEES ONLY | |||
| Signature | |||