| No: B-613 | Date: 23/04/2026 | ||
| Patient Name: KAVYA VANRAJ THAKOR | |||
| Age: 4M | M/F: FEMALE | ||
| Address:- PATAN | |||
| D.O.A.: 19/04/2026 | D.O.D.: 23/04/2026 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 3,000.00 | 15,000.00 |
| TOTAL | 15000.00 | ||
| IN WORDS : FIFTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||