| No: B-137 | Date: 22/06/2025 | ||
| Patient Name: JENISH ALPESHBHAI SATHVARA | |||
| Age: 3YRS | M/F: MALE | ||
| Address:- RADHNPUR | |||
| D.O.A.: 20/06/2025 | D.O.D.: 22/06/2025 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 3,500.00 | 10,500.00 |
| TOTAL | 10500.00 | ||
| IN WORDS : TEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||