| No: B-482 | Date: 12/01/2026 | ||
| Patient Name: MADHAVI KISHAN PATHAK | |||
| Age: 5Y | M/F: FEMALE | ||
| Address:- BHABHAR | |||
| D.O.A.: 09/01/2026 | D.O.D.: 12/01/2026 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 2,000.00 | 8,000.00 |
| TOTAL | 8000.00 | ||
| IN WORDS : EIGHT THOUSAND RUPEES ONLY | |||
| Signature | |||