| No: B-427 | Date: 12/12/2025 | ||
| Patient Name: JISHA HARSHIL SADHU | |||
| Age: 3Y | M/F: FEMALE | ||
| Address:- PATAN | |||
| D.O.A.: 09/12/2025 | D.O.D.: 12/12/2025 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 2,500.00 | 10,000.00 |
| TOTAL | 10000.00 | ||
| IN WORDS : TEN THOUSAND RUPEES ONLY | |||
| Signature | |||