| No: B-634 | Date: 07/05/2026 | ||
| Patient Name: SHIVA SHRAVANJI THAKOR | |||
| Age: 3Y | M/F: MALE | ||
| Address:- NAVRANGPURA | |||
| D.O.A.: 04/05/2026 | D.O.D.: 07/05/2026 | ||
| Diagnosis: MESENTERIC ADENITIS VOMITING , ABDOMINAL PAIN | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 5,000.00 | 20,000.00 |
| TOTAL | 20000.00 | ||
| IN WORDS : TWENTY THOUSAND RUPEES ONLY | |||
| Signature | |||