| No: B-638 | Date: 12/05/2026 | ||
| Patient Name: HETANSHI DINESHBHAI PATANI | |||
| Age: 9M | M/F: FEMALE | ||
| Address:- PATAN | |||
| D.O.A.: 09/05/2026 | D.O.D.: 12/05/2026 | ||
| Diagnosis: FEVER | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 5,000.00 | 20,000.00 |
| TOTAL | 20000.00 | ||
| IN WORDS : TWENTY THOUSAND RUPEES ONLY | |||
| Signature | |||