| No: B-666 | Date: 16/06/2026 | ||
| Patient Name: BABO ROHIT THAKOR | |||
| Age: 8D | M/F: MALE | ||
| Address:- SHANKHESWER | |||
| D.O.A.: 12/06/2026 | D.O.D.: 16/06/2026 | ||
| Diagnosis: NEPHOTOC SYNDROM | |||
| 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 | |||