| No: B-72 | Date: 28/04/2025 | ||
| Patient Name: FIDA AMINBHAI SUNSARA | |||
| Age: 1.5YRS | M/F: FEMALE | ||
| Address:- VADU | |||
| D.O.A.: 25/04/2025 | D.O.D.: 28/04/2025 | ||
| Diagnosis: S - ENEMIA WITH FEVER WITH VOMITING | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,000.00 | 12,000.00 |
| TOTAL | 12000.00 | ||
| IN WORDS : TWELVE THOUSAND RUPEES ONLY | |||
| Signature | |||