| No: B-259 | Date: 24/08/2025 | ||
| Patient Name: BABO VIKRAM PATANI | |||
| Age: 1Y | M/F: MALE | ||
| Address:- DEVPURA | |||
| D.O.A.: 21/08/2025 | D.O.D.: 24/08/2025 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 1,000.00 | 4,000.00 |
| TOTAL | 4000.00 | ||
| IN WORDS : FOUR THOUSAND RUPEES ONLY | |||
| Signature | |||