| No: B-582 | Date: 26/03/2026 | ||
| Patient Name: MITAL ALPESHJI THAKOR | |||
| Age: 1.5Y | M/F: FEMALE | ||
| Address:- AMBALA | |||
| D.O.A.: 23/03/2026 | D.O.D.: 26/03/2026 | ||
| Diagnosis: CONVERSION WITH FEVER | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,000.00 | 12,000.00 |
| TOTAL | 12000.00 | ||
| IN WORDS : TWELVE THOUSAND RUPEES ONLY | |||
| Signature | |||