| No: B-506 | Date: 30/01/2026 | ||
| Patient Name: ASHIK MUKESHJI THAKOR | |||
| Age: 5Y | M/F: MALE | ||
| Address:- MUDWADA | |||
| D.O.A.: 26/01/2026 | D.O.D.: 30/01/2026 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 1,500.00 | 4,500.00 |
| TOTAL | 4500.00 | ||
| IN WORDS : FOUR THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||