| No: B-511 | Date: 05/02/2026 | ||
| Patient Name: NENSHI SURESHJI THAKOR | |||
| Age: 6M | M/F: FEMALE | ||
| Address:- DODIWADA | |||
| D.O.A.: 02/02/2026 | D.O.D.: 05/02/2026 | ||
| Diagnosis: PNUMONIA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 3,000.00 | 9,000.00 |
| TOTAL | 9000.00 | ||
| IN WORDS : NINE THOUSAND RUPEES ONLY | |||
| Signature | |||