| No: B-520 | Date: 11/02/2026 | ||
| Patient Name: DHAVAL GOVIND JADAV | |||
| Age: 2Y | M/F: MALE | ||
| Address:- SAMAU | |||
| D.O.A.: 08/02/2026 | D.O.D.: 11/02/2026 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| 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 | |||