| No: B-546 | Date: 08/03/2026 | ||
| Patient Name: SHIVANSH J.DESAI | |||
| Age: 11Y | M/F: MALE | ||
| Address:- PATAN | |||
| D.O.A.: 04/03/2026 | D.O.D.: 08/03/2026 | ||
| Diagnosis: PNUMONIA WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 2,500.00 | 12,500.00 |
| TOTAL | 12500.00 | ||
| IN WORDS : TWELVE THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||