| No: B-462 | Date: 01/01/2026 | ||
| Patient Name: PURVI RANCHODJI THAKOR | |||
| Age: 3Y | M/F: FEMALE | ||
| Address:- GODA | |||
| D.O.A.: 29/12/2025 | D.O.D.: 01/01/2026 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 1,500.00 | 7,500.00 |
| TOTAL | 7500.00 | ||
| IN WORDS : SEVEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||