| No: B-457 | Date: 31/12/2025 | ||
| Patient Name: KHADIJA HARISH MADHIYA | |||
| Age: 5Y | M/F: FEMALE | ||
| Address:- BHILWAN | |||
| D.O.A.: 27/12/2025 | D.O.D.: 31/12/2025 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 4,000.00 | 16,000.00 |
| TOTAL | 16000.00 | ||
| IN WORDS : SIXTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||