| No: B-631 | Date: 07/05/2026 | ||
| Patient Name: UTSAV UTTAM SOLANKI | |||
| Age: 2Y | M/F: MALE | ||
| Address:- RAJPUR | |||
| D.O.A.: 02/05/2026 | D.O.D.: 07/05/2026 | ||
| Diagnosis: D | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 3,500.00 | 17,500.00 |
| TOTAL | 17500.00 | ||
| IN WORDS : SEVENTEEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||