| No: B-481 | Date: 12/01/2026 | ||
| Patient Name: VIHAN MUKESH OD | |||
| Age: 15M | M/F: MALE | ||
| Address:- UN-THARA | |||
| D.O.A.: 08/01/2026 | D.O.D.: 12/01/2026 | ||
| Diagnosis: DIABETES TRETMENT | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 4,500.00 | 22,500.00 |
| TOTAL | 22500.00 | ||
| IN WORDS : TWENTY-TWO THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||