| No: B-622 | Date: 30/04/2026 | ||
| Patient Name: SHREEYAN G. GHODA | |||
| Age: 3Y | M/F: MALE | ||
| Address:- KATRA | |||
| D.O.A.: 27/04/2026 | D.O.D.: 30/04/2026 | ||
| Diagnosis: AGE SOME DEHYDRATION WITH SEPTICEMIA WITH VOMITING WITH FEVER | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,500.00 | 14,000.00 |
| TOTAL | 14000.00 | ||
| IN WORDS : FOURTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||