| No: B-661 | Date: 12/06/2026 | ||
| Patient Name: ARVIND MAHESHJI THAKOR | |||
| Age: 4M | M/F: MALE | ||
| Address:- NAYTA | |||
| D.O.A.: 09/06/2026 | D.O.D.: 12/06/2026 | ||
| Diagnosis: COUGH AND COLD WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 4,000.00 | 16,000.00 |
| TOTAL | 16000.00 | ||
| IN WORDS : SIXTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||