| No: B-297 | Date: 15/09/2025 | ||
| Patient Name: SIDDRAJ SUNIL JAGANI | |||
| Age: 7Y | M/F: MALE | ||
| Address:- THARA | |||
| D.O.A.: 12/09/2025 | D.O.D.: 15/09/2025 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL | 7500.00 | ||
| IN WORDS : SEVEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||