| No: B-354 | Date: 12/10/2025 | ||
| Patient Name: MO IMRAN BHORANIYA | |||
| Age: 15M | M/F: MALE | ||
| Address:- BHILVAN | |||
| D.O.A.: 09/10/2025 | D.O.D.: 12/10/2025 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 5,000.00 | 25,000.00 |
| TOTAL | 25000.00 | ||
| IN WORDS : TWENTY-FIVE THOUSAND RUPEES ONLY | |||
| Signature | |||