| No: B-564 | Date: 16/03/2026 | ||
| Patient Name: RUDRAX JAYKUMAR TRIVEDI | |||
| Age: 5D | M/F: MALE | ||
| Address:- PATAN | |||
| D.O.A.: 12/03/2026 | D.O.D.: 16/03/2026 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 2,000.00 | 8,000.00 |
| TOTAL | 8000.00 | ||
| IN WORDS : EIGHT THOUSAND RUPEES ONLY | |||
| Signature | |||