| No: B-214 | Date: 02/08/2025 | ||
| Patient Name: INAYA ASAD MANSIYA | |||
| Age: 6M | M/F: FEMALE | ||
| Address:- VADANI | |||
| D.O.A.: 30/07/2025 | D.O.D.: 02/08/2025 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 2,500.00 | 10,000.00 |
| TOTAL | 10000.00 | ||
| IN WORDS : TEN THOUSAND RUPEES ONLY | |||
| Signature | |||