| No: B-169 | Date: 14/07/2025 | ||
| Patient Name: VANSH JITENDRA JAGANI | |||
| Age: 11Y | M/F: MALE | ||
| Address:- THARA | |||
| D.O.A.: 11/07/2025 | D.O.D.: 14/07/2025 | ||
| Diagnosis: VIRAL HEPATITIS WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 2,600.00 | 10,400.00 |
| TOTAL | 10400.00 | ||
| IN WORDS : TEN THOUSAND, FOUR HUNDRED RUPEES ONLY | |||
| Signature | |||