| No: B-556 | Date: 18/03/2026 | ||
| Patient Name: BABO KAKUJI THAKOR | |||
| Age: 6D | M/F: MALE | ||
| Address:- LAVARA | |||
| D.O.A.: 09/03/2026 | D.O.D.: 18/03/2026 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 9 | 1,500.00 | 13,500.00 |
| TOTAL | 13500.00 | ||
| IN WORDS : THIRTEEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||