| No: B-50 | Date: 21/04/2025 | ||
| Patient Name: ADIYTA AJAYBHAI PATANI | |||
| Age: 2YRS | M/F: MALE | ||
| Address:- DEESA | |||
| D.O.A.: 17/04/2025 | D.O.D.: 21/04/2025 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 4,000.00 | 16,000.00 |
| TOTAL | 16000.00 | ||
| IN WORDS : SIXTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||