| No: B-629 | Date: 03/05/2026 | ||
| Patient Name: DITYA SACHIN PATEL | |||
| Age: 3.5Y | M/F: FEMALE | ||
| Address:- PATAN | |||
| D.O.A.: 01/05/2026 | D.O.D.: 03/05/2026 | ||
| Diagnosis: FEBRIAL SUZIER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 4,500.00 | 13,500.00 |
| TOTAL | 13500.00 | ||
| IN WORDS : THIRTEEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||