| No: B-512 | Date: 06/02/2026 | ||
| Patient Name: HEER VIJAYBHAI PATEL | |||
| Age: 6Y | M/F: FEMALE | ||
| Address:- PATAN | |||
| D.O.A.: 03/02/2026 | D.O.D.: 06/02/2026 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 3,500.00 | 10,500.00 |
| TOTAL | 10500.00 | ||
| IN WORDS : TEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||