| No: B-456 | Date: 30/12/2025 | ||
| Patient Name: VISHAL NAVGAN THAKOR | |||
| Age: 16Y | M/F: MALE | ||
| Address:- MANIPUR | |||
| D.O.A.: 26/12/2025 | D.O.D.: 30/12/2025 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,000.00 | 12,000.00 |
| TOTAL | 12000.00 | ||
| IN WORDS : TWELVE THOUSAND RUPEES ONLY | |||
| Signature | |||