| No: B-509 | Date: 04/02/2026 | ||
| Patient Name: HARDIK VIRAM DESAI | |||
| Age: 3.5Y | M/F: MALE | ||
| Address:- JASANWADA | |||
| D.O.A.: 01/02/2026 | D.O.D.: 04/02/2026 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| 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 | |||