| No: B-435 | Date: 17/12/2025 | ||
| Patient Name: VISESH SHIVA RABARI | |||
| Age: 9Y | M/F: MALE | ||
| Address:- THARAD | |||
| D.O.A.: 15/12/2025 | D.O.D.: 17/12/2025 | ||
| Diagnosis: MESENTERIC ADENITIS WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 3,000.00 | 9,000.00 |
| TOTAL | 9000.00 | ||
| IN WORDS : NINE THOUSAND RUPEES ONLY | |||
| Signature | |||