| No: B-497 | Date: 21/01/2026 | ||
| Patient Name: VIVAN MAULIKPURI | |||
| Age: 3Y | M/F: MALE | ||
| Address:- KHOBHEL | |||
| D.O.A.: 18/01/2026 | D.O.D.: 21/01/2026 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 1,200.00 | 4,800.00 |
| TOTAL | 4800.00 | ||
| IN WORDS : FOUR THOUSAND, EIGHT HUNDRED RUPEES ONLY | |||
| Signature | |||