| No: B-643 | Date: 16/05/2026 | ||
| Patient Name: BABO PRAKASHJI THAKOR | |||
| Age: 4D | M/F: MALE | ||
| Address:- KATRA | |||
| D.O.A.: 14/05/2026 | D.O.D.: 16/05/2026 | ||
| Diagnosis: FEVER | |||
| 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 | |||