| No: B-70 | Date: 27/04/2025 | ||
| Patient Name: VISHAL HIRABHAI VALMIKI | |||
| Age: 5YRS | M/F: FEMALE | ||
| Address:- KANSHA | |||
| D.O.A.: 24/04/2025 | D.O.D.: 27/04/2025 | ||
| Diagnosis: CONVERSION WITH FEVER | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 2 | 3,500.00 | 7,000.00 |
| TOTAL | 7000.00 | ||
| IN WORDS : SEVEN THOUSAND RUPEES ONLY | |||
| Signature | |||