| No: B-618 | Date: 26/04/2026 | ||
| Patient Name: ADITYA VIJAY THAKOR | |||
| Age: 5Y | M/F: MALE | ||
| Address:- RODA | |||
| D.O.A.: 23/04/2026 | D.O.D.: 26/04/2026 | ||
| Diagnosis: COUGH AND COLD WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,000.00 | 12,000.00 |
| TOTAL | 12000.00 | ||
| IN WORDS : TWELVE THOUSAND RUPEES ONLY | |||
| Signature | |||