| No: B-577 | Date: 23/03/2026 | ||
| Patient Name: AFIYA SOHIL KADIWALA | |||
| Age: 7Y | M/F: FEMALE | ||
| Address:- BASU | |||
| D.O.A.: 21/03/2026 | D.O.D.: 23/03/2026 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 2,500.00 | 10,000.00 |
| TOTAL | 10000.00 | ||
| IN WORDS : TEN THOUSAND RUPEES ONLY | |||
| Signature | |||