| No: B-447 | Date: 25/12/2025 | ||
| Patient Name: MISHA ROHIT PATEL | |||
| Age: 6Y | M/F: FEMALE | ||
| Address:- KAMLIWADA | |||
| D.O.A.: 21/12/2025 | D.O.D.: 25/12/2025 | ||
| Diagnosis: DIABETES TRETMENT | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 2,000.00 | 10,000.00 |
| TOTAL | 10000.00 | ||
| IN WORDS : TEN THOUSAND RUPEES ONLY | |||
| Signature | |||