| No: B-683 | Date: 28/06/2026 | ||
| Patient Name: BABO KALU PATANI | |||
| Age: 2.5M | M/F: MALE | ||
| Address:- JAMPUR | |||
| D.O.A.: 25/06/2026 | D.O.D.: 28/06/2026 | ||
| Diagnosis: COUGH AND COLD WITH FEVER WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 4,500.00 | 13,500.00 |
| TOTAL | 13500.00 | ||
| IN WORDS : THIRTEEN THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||