| No: B-686 | Date: 01/07/2026 | ||
| Patient Name: SHIDDRADH DINESHBHAI PRAJAPATI | |||
| Age: 5Y | M/F: MALE | ||
| Address:- BHALANA | |||
| D.O.A.: 30/06/2026 | D.O.D.: 01/07/2026 | ||
| Diagnosis: MESENTERIC ADENITIS WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 2 | 5,000.00 | 10,000.00 |
| TOTAL | 10000.00 | ||
| IN WORDS : TEN THOUSAND RUPEES ONLY | |||
| Signature | |||