| No: B-398 | Date: 28/11/2025 | ||
| Patient Name: ARMAN MO. ILIYAS | |||
| Age: 10Y | M/F: MALE | ||
| Address:- PADLA | |||
| D.O.A.: 25/11/2025 | D.O.D.: 28/11/2025 | ||
| Diagnosis: SEPTICEMIA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 5,000.00 | 15,000.00 |
| TOTAL | 15000.00 | ||
| IN WORDS : FIFTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||