| No: B-76 | Date: 02/05/2025 | ||
| Patient Name: KRIYANSH PINTUJI THAKOR | |||
| Age: 3YRS | M/F: MALE | ||
| Address:- MUJPUR | |||
| D.O.A.: 29/04/2025 | D.O.D.: 02/05/2025 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 4,000.00 | 20,000.00 |
| TOTAL | 20000.00 | ||
| IN WORDS : TWENTY THOUSAND RUPEES ONLY | |||
| Signature | |||