| No: B-409 | Date: 29/11/2025 | ||
| Patient Name: KRISHNA MANISH THAKOR | |||
| Age: 3Y | M/F: FEMALE | ||
| Address:- ADIPUR | |||
| D.O.A.: 28/11/2025 | D.O.D.: 29/11/2025 | ||
| Diagnosis: SEPTICEMIA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 4,000.00 | 12,000.00 |
| TOTAL | 12000.00 | ||
| IN WORDS : TWELVE THOUSAND RUPEES ONLY | |||
| Signature | |||