| No: B-685 | Date: 30/06/2026 | ||
| Patient Name: SONAKSHI RAKESHBHAI PATANNI | |||
| Age: 5Y | M/F: FEMALE | ||
| Address:- TANK VASANA | |||
| D.O.A.: 28/06/2026 | D.O.D.: 30/06/2026 | ||
| Diagnosis: JONDICE WITH VOMITING WITH DEHYDRATON | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 3 | 4,000.00 | 12,000.00 |
| TOTAL | 12000.00 | ||
| IN WORDS : TWELVE THOUSAND RUPEES ONLY | |||
| Signature | |||