| No: B-199 | Date: 27/07/2025 | ||
| Patient Name: VIYAN SURESHBHAI PATEL | |||
| Age: 2.5Y | M/F: MALE | ||
| Address:- MESAR | |||
| D.O.A.: 24/07/2025 | D.O.D.: 27/07/2025 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,500.00 | 14,000.00 |
| TOTAL | 14000.00 | ||
| IN WORDS : FOURTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||