| No: B-625 | Date: 30/04/2026 | ||
| Patient Name: MOHAMD SABIR KAJI | |||
| Age: 7Y | M/F: MALE | ||
| Address:- SAMI | |||
| D.O.A.: 28/04/2026 | D.O.D.: 30/04/2026 | ||
| Diagnosis: DIABITIS TRETMENT | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 4,000.00 | 12,000.00 |
| TOTAL | 12000.00 | ||
| IN WORDS : TWELVE THOUSAND RUPEES ONLY | |||
| Signature | |||