| No: B-641 | Date: 15/05/2026 | ||
| Patient Name: DEVANSH DALABHAI RABARI | |||
| Age: 4Y | M/F: MALE | ||
| Address:- VAGDOD | |||
| D.O.A.: 12/05/2026 | D.O.D.: 15/05/2026 | ||
| Diagnosis: FEVER | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 2,500.00 | 10,000.00 |
| TOTAL | 10000.00 | ||
| IN WORDS : TEN THOUSAND RUPEES ONLY | |||
| Signature | |||