| No: B-587 | Date: 31/03/2026 | ||
| Patient Name: BABO JIGAR THAKOR | |||
| Age: 8M | M/F: MALE | ||
| Address:- SAMSERPUARA | |||
| D.O.A.: 27/03/2026 | D.O.D.: 31/03/2026 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 3,000.00 | 15,000.00 |
| TOTAL | 15000.00 | ||
| IN WORDS : FIFTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||