| No: B-138 | Date: 24/06/2025 | ||
| Patient Name: AYUSH KIRANBHAI THAKOR | |||
| Age: 8M | M/F: MALE | ||
| Address:- SAREL | |||
| D.O.A.: 23/06/2025 | D.O.D.: 24/06/2025 | ||
| Diagnosis: CONVERSION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 4,000.00 | 12,000.00 |
| TOTAL | 12000.00 | ||
| IN WORDS : TWELVE THOUSAND RUPEES ONLY | |||
| Signature | |||