| No: B-566 | Date: 16/03/2026 | ||
| Patient Name: ASHVIN DINESHBHAI PATEL | |||
| Age: 11Y | M/F: MALE | ||
| Address:- DEODAR | |||
| D.O.A.: 13/03/2026 | D.O.D.: 16/03/2026 | ||
| Diagnosis: FEVER WITH CHIKANGUNIYA | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 1,500.00 | 6,000.00 |
| TOTAL | 6000.00 | ||
| IN WORDS : SIX THOUSAND RUPEES ONLY | |||
| Signature | |||