| No: B-606 | Date: 17/04/2026 | ||
| Patient Name: BABO JIGIBEN THAKOR | |||
| Age: 3D | M/F: MALE | ||
| Address:- NORTA | |||
| D.O.A.: 14/04/2026 | D.O.D.: 17/04/2026 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 4,500.00 | 18,000.00 |
| TOTAL | 18000.00 | ||
| IN WORDS : EIGHTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||