| No: B-305 | Date: 27/09/2025 | ||
| Patient Name: SURESH MUKESH THAKOR | |||
| Age: 2.5M | M/F: MALE | ||
| Address:- SAMAU | |||
| D.O.A.: 17/09/2025 | D.O.D.: 27/09/2025 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 10 | 1,500.00 | 15,000.00 |
| TOTAL | 15000.00 | ||
| IN WORDS : FIFTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||