| No: B-165 | Date: 15/07/2025 | ||
| Patient Name: DIVYANSH MEHUL RAVAL | |||
| Age: 1.5Y | M/F: MALE | ||
| Address:- SHANKESWER | |||
| D.O.A.: 10/07/2025 | D.O.D.: 15/07/2025 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 2,500.00 | 12,500.00 |
| TOTAL | 12500.00 | ||
| IN WORDS : TWELVE THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||