| No: B-651 | Date: 24/05/2026 | ||
| Patient Name: ADHYA BAKAJI THAKOR | |||
| Age: 1.5Y | M/F: FEMALE | ||
| Address:- NAYTA | |||
| D.O.A.: 22/05/2026 | D.O.D.: 24/05/2026 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 5,000.00 | 15,000.00 |
| TOTAL | 15000.00 | ||
| IN WORDS : FIFTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||