| No: B-567 | Date: 18/03/2026 | ||
| Patient Name: ALI MUJAHID DHUKKA | |||
| Age: 14M | M/F: MALE | ||
| Address:- KOITA | |||
| D.O.A.: 14/03/2026 | D.O.D.: 18/03/2026 | ||
| Diagnosis: DIARRHOEA 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 | |||