| No: B-675 | Date: 22/06/2026 | ||
| Patient Name: VANSHRAJ INDRAJEETSHINH VAGHELA | |||
| Age: 3M | M/F: MALE | ||
| Address:- BHILOT | |||
| D.O.A.: 16/06/2026 | D.O.D.: 22/06/2026 | ||
| Diagnosis: FEVER | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL | 18000.00 | ||
| IN WORDS : EIGHTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||