| No: B-649 | Date: 24/05/2026 | ||
| Patient Name: DIVYA VIVEK PATEL | |||
| Age: 5Y | M/F: MALE | ||
| Address:- PATAN | |||
| D.O.A.: 21/05/2026 | D.O.D.: 24/05/2026 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 4,000.00 | 20,000.00 |
| TOTAL | 20000.00 | ||
| IN WORDS : TWENTY THOUSAND RUPEES ONLY | |||
| Signature | |||