| No: B-574 | Date: 21/03/2026 | ||
| Patient Name: BABO SANJAYSINH DARBAR | |||
| Age: 12D | M/F: MALE | ||
| Address:- KUNGHER | |||
| D.O.A.: 19/03/2026 | D.O.D.: 21/03/2026 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 2,500.00 | 7,500.00 |
| TOTAL | 7500.00 | ||
| IN WORDS : SEVEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||