| No: B-485 | Date: 15/01/2026 | ||
| Patient Name: BABO VIPULBHAI THAKOR | |||
| Age: 7M | M/F: MALE | ||
| Address:- PATAN | |||
| D.O.A.: 10/01/2026 | D.O.D.: 15/01/2026 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 6 | 2,000.00 | 12,000.00 |
| TOTAL | 12000.00 | ||
| IN WORDS : TWELVE THOUSAND RUPEES ONLY | |||
| Signature | |||