| No: B-399 | Date: 27/11/2025 | ||
| Patient Name: KAVYA VIJAYBHAI THAKOR | |||
| Age: 2.5Y | M/F: MALE | ||
| Address:- MESAR | |||
| D.O.A.: 26/11/2025 | D.O.D.: 27/11/2025 | ||
| Diagnosis: SEPTICEMIA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 2 | 5,000.00 | 10,000.00 |
| TOTAL | 10000.00 | ||
| IN WORDS : TEN THOUSAND RUPEES ONLY | |||
| Signature | |||