| No: B-173 | Date: 16/07/2025 | ||
| Patient Name: SHIVANI RAMESHBHAI CHAUDHARI | |||
| Age: 7Y | M/F: FEMALE | ||
| Address:- GOLAVI | |||
| D.O.A.: 14/07/2025 | D.O.D.: 16/07/2025 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 3,800.00 | 11,400.00 |
| TOTAL | 11400.00 | ||
| IN WORDS : ELEVEN THOUSAND, FOUR HUNDRED RUPEES ONLY | |||
| Signature | |||