| No: B-85 | Date: 17/05/2025 | ||
| Patient Name: POOJABEN PANCHABHAI SUTHAR | |||
| Age: 3YRS | M/F: FEMALE | ||
| Address:- UDAI | |||
| D.O.A.: 12/05/2025 | D.O.D.: 17/05/2025 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 2,700.00 | 8,100.00 |
| TOTAL | 8100.00 | ||
| IN WORDS : EIGHT THOUSAND, ONE HUNDRED RUPEES ONLY | |||
| Signature | |||