| No: B-158 | Date: 07/07/2025 | ||
| Patient Name: ASHMITA PRAVIN THAKOR | |||
| Age: 2Y | M/F: FEMALE | ||
| Address:- JUNAMOKA | |||
| D.O.A.: 05/07/2025 | D.O.D.: 07/07/2025 | ||
| Diagnosis: VIRAL DIAHERIA WITH VOMITING WITH DEHYDRATION | |||
| 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 | |||