| No: B-166 | Date: 15/07/2025 | ||
| Patient Name: MAYA PRAVIN THAKOR | |||
| Age: 4Y | M/F: FEMALE | ||
| Address:- RODA | |||
| D.O.A.: 10/07/2025 | D.O.D.: 15/07/2025 | ||
| Diagnosis: FEBRIAL SUIZER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 600.00 | 3,000.00 |
| TOTAL | 3000.00 | ||
| IN WORDS : THREE THOUSAND RUPEES ONLY | |||
| Signature | |||