| No: B-402 | Date: 28/11/2025 | ||
| Patient Name: CHETAN VIRAL DARJI | |||
| Age: 2Y | M/F: MALE | ||
| Address:- BALISANA | |||
| D.O.A.: 28/11/2025 | D.O.D.: 28/11/2025 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL | 8000.00 | ||
| IN WORDS : EIGHT THOUSAND RUPEES ONLY | |||
| Signature | |||