| No: B-633 | Date: 06/05/2026 | ||
| Patient Name: TORALBA DANUBHA VAGHELA | |||
| Age: 4Y | M/F: FEMALE | ||
| Address:- UMBARI | |||
| D.O.A.: 03/05/2026 | D.O.D.: 06/05/2026 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,500.00 | 14,000.00 |
| TOTAL | 14000.00 | ||
| IN WORDS : FOURTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||