| No: B-64 | Date: 26/04/2025 | ||
| Patient Name: PIYUSH AMRATJI THAKOR | |||
| Age: 3YRS | M/F: MALE | ||
| Address:- RUGHNATHPURA | |||
| D.O.A.: 23/04/2025 | D.O.D.: 26/04/2025 | ||
| Diagnosis: CONVERSION WITH FEVER | |||
| 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 | |||