| No: B-490 | Date: 17/01/2026 | ||
| Patient Name: VED AXAY THAKKAR | |||
| Age: 1Y | M/F: MALE | ||
| Address:- PATAN | |||
| D.O.A.: 13/01/2026 | D.O.D.: 17/01/2026 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 1,200.00 | 6,000.00 |
| TOTAL | 6000.00 | ||
| IN WORDS : SIX THOUSAND RUPEES ONLY | |||
| Signature | |||