| No: B-665 | Date: 15/06/2026 | ||
| Patient Name: MALHAR SHAKTIDAN GADHAVI | |||
| Age: 18M | M/F: MALE | ||
| Address:- RADHANPUR | |||
| D.O.A.: 11/06/2026 | D.O.D.: 15/06/2026 | ||
| Diagnosis: THYPOID 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 | |||