| No: B-2 | Date: 02/04/2025 | ||
| Patient Name: CHIRAG BHARATJI THAKOR | |||
| Age: 3YRS | M/F: MALE | ||
| Address:- TARABH | |||
| D.O.A.: 01/04/2025 | D.O.D.: 02/04/2025 | ||
| Diagnosis: CONVERSION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 2 | 3,750.00 | 7,500.00 |
| TOTAL | 7500.00 | ||
| IN WORDS : SEVEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||