| No: B-77 | Date: 02/05/2025 | ||
| Patient Name: MITANSHI LEBUJI THAKOR | |||
| Age: 4YRS | M/F: FEMALE | ||
| Address:- DASAWADA | |||
| D.O.A.: 30/04/2025 | D.O.D.: 02/05/2025 | ||
| Diagnosis: DIARRHOEA WITH VOMITING WITH DEHYDRATION | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 4 | 3,250.00 | 13,000.00 |
| TOTAL | 13000.00 | ||
| IN WORDS : THIRTEEN THOUSAND RUPEES ONLY | |||
| Signature | |||