| No: B-87 | Date: 15/05/2025 | ||
| Patient Name: PRIYALBA JAYNTIJI THAKOR | |||
| Age: 7YRS | M/F: FEMALE | ||
| Address:- KUMBUVA | |||
| D.O.A.: 13/05/2025 | D.O.D.: 15/05/2025 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,600.00 | 14,400.00 |
| TOTAL | 14400.00 | ||
| IN WORDS : FOURTEEN THOUSAND, FOUR HUNDRED RUPEES ONLY | |||
| Signature | |||