| No: B-593 | Date: 02/04/2026 | ||
| Patient Name: MOHAMAD SANJALA MACCHIYA | |||
| Age: 12D | M/F: FEMALE | ||
| Address:- BHILWAN | |||
| D.O.A.: 01/04/2026 | D.O.D.: 02/04/2026 | ||
| Diagnosis: FEVER | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 2 | 5,500.00 | 11,000.00 |
| TOTAL | 11000.00 | ||
| IN WORDS : ELEVEN THOUSAND RUPEES ONLY | |||
| Signature | |||