| No: B-657 | Date: 10/06/2026 | ||
| Patient Name: SANVI SHRAVANJI THAKOR | |||
| Age: 1Y | M/F: FEMALE | ||
| Address:- JABDIYA | |||
| D.O.A.: 07/06/2026 | D.O.D.: 10/06/2026 | ||
| Diagnosis: FEVER WITH BRONCHITIS | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 4,000.00 | 16,000.00 |
| TOTAL | 16000.00 | ||
| IN WORDS : SIXTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||