| No: B-616 | Date: 24/04/2026 | ||
| Patient Name: BABY VIPUL PATANI | |||
| Age: 12D | M/F: FEMALE | ||
| Address:- PATAN | |||
| D.O.A.: 21/04/2026 | D.O.D.: 24/04/2026 | ||
| Diagnosis: SEPTICEMIA WITH JONDICE WITH FEVER WITH RDS | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,500.00 | 14,000.00 |
| TOTAL | 14000.00 | ||
| IN WORDS : FOURTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||