| No: B-605 | Date: 14/04/2026 | ||
| Patient Name: AYANSH JIGARJI SOLANKI | |||
| Age: 4M | M/F: MALE | ||
| Address:- SARVA | |||
| D.O.A.: 12/04/2026 | D.O.D.: 14/04/2026 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 5,500.00 | 16,500.00 |
| TOTAL | 16500.00 | ||
| IN WORDS : SIXTEEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||