| No: B-505 | Date: 28/01/2026 | ||
| Patient Name: DEVANSHI DASARTBHAI PANCHAL | |||
| Age: 3.5YRS | M/F: FEMALE | ||
| Address:- MOJRU | |||
| D.O.A.: 24/01/2026 | D.O.D.: 28/01/2026 | ||
| Diagnosis: MESENTERIC ADENITIS WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 200.00 | 800.00 |
| TOTAL | 800.00 | ||
| IN WORDS : EIGHT HUNDRED RUPEES ONLY | |||
| Signature | |||