| No: B-630 | Date: 05/05/2026 | ||
| Patient Name: RENA JAYESH DESAI | |||
| Age: 15Y | M/F: FEMALE | ||
| Address:- MEHSANA | |||
| D.O.A.: 01/05/2026 | D.O.D.: 05/05/2026 | ||
| Diagnosis: DIARREA VOMITING FEVER | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 6 | 2,500.00 | 15,000.00 |
| TOTAL | 15000.00 | ||
| IN WORDS : FIFTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||