| No: B-579 | Date: 27/03/2026 | ||
| Patient Name: FERI A. PARMAR | |||
| Age: 15M | M/F: FEMALE | ||
| Address:- RASULPUR | |||
| D.O.A.: 22/03/2026 | D.O.D.: 27/03/2026 | ||
| Diagnosis: CONVERSION WITH FEVER | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 6 | 1,500.00 | 9,000.00 |
| TOTAL | 9000.00 | ||
| IN WORDS : NINE THOUSAND RUPEES ONLY | |||
| Signature | |||