| No: B-561 | Date: 14/03/2026 | ||
| Patient Name: CHIRAG LALJI RABARI | |||
| Age: 2.5Y | M/F: MALE | ||
| Address:- RAPAR | |||
| D.O.A.: 10/03/2026 | D.O.D.: 14/03/2026 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL | 12500.00 | ||
| IN WORDS : TWELVE THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||