| No: B-627 | Date: 02/05/2026 | ||
| Patient Name: RIYANSH LADJIBHAI THAKOR | |||
| Age: 1.5M | M/F: MALE | ||
| Address:- DUCHKWADA | |||
| D.O.A.: 29/04/2026 | D.O.D.: 02/05/2026 | ||
| Diagnosis: FEVER WITH BRONCHITIS | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 4,000.00 | 16,000.00 |
| TOTAL | 16000.00 | ||
| IN WORDS : SIXTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||