| No: B-353 | Date: 19/10/2025 | ||
| Patient Name: HAMJA MOHAMAD SUNSARA | |||
| Age: 4Y | M/F: FEMALE | ||
| Address:- VADU | |||
| D.O.A.: 16/10/2025 | D.O.D.: 19/10/2025 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL | 4004.00 | ||
| IN WORDS : FOUR THOUSAND AND FOUR RUPEES ONLY | |||
| Signature | |||