| No: B-674 | Date: 22/06/2026 | ||
| Patient Name: KRIYANSH BHAVESH PATEL | |||
| Age: 2.5Y | M/F: MALE | ||
| Address:- KALANA | |||
| D.O.A.: 17/06/2026 | D.O.D.: 22/06/2026 | ||
| Diagnosis: DENGUE LIKE INLESS WITH VOMITING WITH DEHYDRATION WITH FEVER | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 6 | 3,500.00 | 21,000.00 |
| TOTAL | 21000.00 | ||
| IN WORDS : TWENTY-ONE THOUSAND RUPEES ONLY | |||
| Signature | |||