| No: B-167 | Date: 16/07/2025 | ||
| Patient Name: SHIV AJAY PATANI | |||
| Age: 11M | M/F: MALE | ||
| Address:- MORPA | |||
| D.O.A.: 11/07/2025 | D.O.D.: 16/07/2025 | ||
| Diagnosis: VIRAL HEPATITIS WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 6 | 2,600.00 | 15,600.00 |
| TOTAL | 15600.00 | ||
| IN WORDS : FIFTEEN THOUSAND, SIX HUNDRED RUPEES ONLY | |||
| Signature | |||