HEALTH CHEK DIAGNOSTICS Ph - 22777700 Report Time: - 5 PM to 6 PM, Monday Closed

Reporting Time: - 5 PM to 6 PM, Lab Time: - 7:30 AM to 6:00 PM, Monday Closed

DOCTOR WISE COLLECTION WITH PATIENT DETAILS & TESTS

CENTERID : 11 / MVPP CHARGE MODE : ALL

Period : 12/05/2011 To 12/05/2011 16/05/2011 11:34 Page 1 of 1

Date Patient Patient Name Compan Charge Discount Net Receipt Refund Balance
Id y
11/476 Health India
### 11111538 Mr. K Theerthamalai Bharti AXA - HealthIndia 1880 0 1880 0 1880
Doctor Home Visit (F,Tech Home Visit (For,Cat-6

Total No 1 1880 0 1880 0 1880

11/478 MD India
### 11111540 Mr. RAYYAN AHMED LIC 70 0 70 0 70
FMR Between Rs. 3,00

Total No 1 70 0 70 0 70

11/479 Jasola BSL

### 11111536 Mr. Y C Sharma Birla Sun Life 1730 0 1730 0 1730
FMR Home Visit with,ECG,CBC,BSL13 (Life)
### 11111539 Mr. SHISH RAM Birla Sun Life 1730 0 1730 0 1730
FMR Home Visit with ,BSL13 (Life),ECG,CBC

Total No 2 3460 0 3460 0 3460

11/480 GZB BSL

### 11111541 Mr. DEVENDRA KUMAR VATS Birla Sun Life 1450 0 1450 1450
BSL(Pre-employment)

Total No 1 1450 0 1450 1450

11/502 City Bank BSL

### 11111537 Mr. Pankaj Berry Birla Sun Life 2570 0 2570 0 2570
FMR Home Visit with ,ECG,CBC,BSL13 (Life),RUA,Cotinine (Urine),Cholestrol
Total/HDL
Total No 1 2570 0 2570 0 2570

Grand Total No 6 9430 0 9430 1450 7980

Note : * = Cancelled Patient
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