| No: B-492 | Date: 20/01/2026 | ||
| Patient Name: PURV RAMESHBHAI DESAI | |||
| Age: 1.6Y | M/F: MALE | ||
| Address:- KANSHA | |||
| D.O.A.: 16/01/2026 | D.O.D.: 20/01/2026 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 1,000.00 | 5,000.00 |
| TOTAL | 5000.00 | ||
| IN WORDS : FIVE THOUSAND RUPEES ONLY | |||
| Signature | |||