| No: B-210 | Date: 31/07/2025 | ||
| Patient Name: JENISH RAKEESH MODI | |||
| Age: 12Y | M/F: MALE | ||
| Address:- PATAN | |||
| D.O.A.: 29/07/2025 | D.O.D.: 31/07/2025 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 900.00 | 2,700.00 |
| TOTAL | 2700.00 | ||
| IN WORDS : TWO THOUSAND, SEVEN HUNDRED RUPEES ONLY | |||
| Signature | |||