| No: B-615 | Date: 25/04/2025 | ||
| Patient Name: MAHI VIKRAM DEVIPUJAK | |||
| Age: 3Y | M/F: FEMALE | ||
| Address:- PATAN | |||
| D.O.A.: 21/04/2026 | D.O.D.: 25/04/2025 | ||
| Diagnosis: BRONCHOLITIS 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 | |||