| No: B-599 | Date: 11/04/2026 | ||
| Patient Name: SOURYA CHETANJI THAKOR | |||
| Age: 1.5Y | M/F: MALE | ||
| Address:- THARA | |||
| D.O.A.: 05/04/2026 | D.O.D.: 11/04/2026 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL | 15000.00 | ||
| IN WORDS : FIFTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||