| No: B-71 | Date: 26/04/0205 | ||
| Patient Name: FATEMA RAHEMANBHAI SHEKH | |||
| Age: 2YRS | M/F: FEMALE | ||
| Address:- DEESA | |||
| D.O.A.: 24/04/2025 | D.O.D.: 26/04/2025 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 1,250.00 | 5,000.00 |
| TOTAL | 5000.00 | ||
| IN WORDS : FIVE THOUSAND RUPEES ONLY | |||
| Signature | |||