| No: B-80 | Date: 01/05/2025 | ||
| Patient Name: MOHAMAD JED MANSURI | |||
| Age: 3YRS | M/F: MALE | ||
| Address:- THARA | |||
| D.O.A.: 27/04/2025 | D.O.D.: 01/05/2025 | ||
| Diagnosis: VIRAL FEVER AND ABDOMINAL PAIN | |||
| Particulars | Days | Unit Cost (Rs.) | Amount (Rs.) |
|---|---|---|---|
| TOTAL ( R/N/D )CHARGE | 5 | 2,500.00 | 12,500.00 |
| TOTAL | 12500.00 | ||
| IN WORDS : TWELVE THOUSAND, FIVE HUNDRED RUPEES ONLY | |||
| Signature | |||