| No: B-624 | Date: 30/04/2026 | ||
| Patient Name: RIYANSH JAYPALSINH VAGHELA | |||
| Age: 9M | M/F: MALE | ||
| Address:- RANAKPUR | |||
| D.O.A.: 27/04/2026 | D.O.D.: 30/04/2026 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| 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 | |||