| No: B-486 | Date: 16/11/2026 | ||
| Patient Name: NIYATI KAMLESH AYAR | |||
| Age: 4Y | M/F: FEMALE | ||
| Address:- BAKUTRA | |||
| D.O.A.: 11/01/2026 | D.O.D.: 16/01/2026 | ||
| Diagnosis: MESENTERIC ADENITIS WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 6 | 1,000.00 | 6,000.00 |
| TOTAL | 6000.00 | ||
| IN WORDS : SIX THOUSAND RUPEES ONLY | |||
| Signature | |||