| No: B-644 | Date: 16/05/2026 | ||
| Patient Name: DIVANSHIBA SURTUBHA VAGHELA | |||
| Age: 28D | M/F: FEMALE | ||
| Address:- BECHRAJI | |||
| D.O.A.: 14/05/2026 | D.O.D.: 16/05/2026 | ||
| Diagnosis: SEPTICEMIA WITH FEVER WITH VOMITING | |||
| 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 | |||