| No: B-303 | Date: 18/09/2025 | ||
| Patient Name: JAYVEER RAJPALJI THAKOR | |||
| Age: 6Y | M/F: MALE | ||
| Address:- MANIPUR | |||
| D.O.A.: 15/09/2025 | D.O.D.: 18/09/2025 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 2,500.00 | 7,500.00 |
| TOTAL | 7500.00 | ||
| IN WORDS : SEVEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||