| No: B-488 | Date: 17/01/2026 | ||
| Patient Name: PRICNE PANABHAI THAKOR | |||
| Age: 3Y | M/F: MALE | ||
| Address:- VATAM | |||
| D.O.A.: 12/01/2026 | D.O.D.: 17/01/2026 | ||
| Diagnosis: SEPTICEMIA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 2,000.00 | 10,000.00 |
| TOTAL | 10000.00 | ||
| IN WORDS : TEN THOUSAND RUPEES ONLY | |||
| Signature | |||