| No: B-682 | Date: 28/06/2026 | ||
| Patient Name: KHUSBU PRAVIN PRAJAPATI | |||
| Age: 13Y | M/F: FEMALE | ||
| Address:- DUDHA RAMPURA | |||
| D.O.A.: 24/06/2026 | D.O.D.: 28/06/2026 | ||
| Diagnosis: FEVER | |||
| 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 | |||