| No: B-668 | Date: 17/06/2026 | ||
| Patient Name: HASNEN SULTANKHAN | |||
| Age: 4Y | M/F: MALE | ||
| Address:- VARAHI | |||
| D.O.A.: 14/06/2026 | D.O.D.: 17/06/2026 | ||
| Diagnosis: DENGUE FEVER | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL | 14000.00 | ||
| IN WORDS : FOURTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||