| No: B-653 | Date: 26/05/2026 | ||
| Patient Name: ASTHA BHARAT THAKOR | |||
| Age: 1.5Y | M/F: FEMALE | ||
| Address:- DEODAR | |||
| D.O.A.: 23/05/2026 | D.O.D.: 26/05/2026 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| 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 | |||