| No: B-503 | Date: 26/01/2026 | ||
| Patient Name: NIYATI VIJAYBHAI VARMA | |||
| Age: 7Y | M/F: FEMALE | ||
| Address:- PATAN | |||
| D.O.A.: 22/01/2026 | D.O.D.: 26/01/2026 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL | 10000.00 | ||
| IN WORDS : TEN THOUSAND RUPEES ONLY | |||
| Signature | |||