SRL

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Receipt No: ICR078390917041 Accession No: 0028KF001117 Date: 25/08/2017 Receipt Date: 25/08/2017

Received with thanks from : MS SONAM SEHGAL Client Code: C000002890

Prescribed by : DR. AJAY BHALLA, FORTIS HOSPITAL, NOIDA

Test Code Test Description Amount


3930H ALKALINE PHOSPHATE SERUM 112.50
2470 HEPATITIS B SURFACE ANTIGEN, SERUM 315.00
9890 HEPATITIS B VIRUS DNA QUANTITATIVE 675.00
2455 HEPATITIS Be ANTIBODIES, SERUM 585.00
1527H BILIRUBIN (TOTAL, DIRECT, INDIRECT), 150.00
SERUM
2456MBI HEPATITIS Be ANTIGEN, SERUM 650.00
1388 LIVER FUNCTION PROFILE 590.00
5110A COMPLETE BLOOD COUNT 500.00
HM138B LIPID PROFILE, SERUM 1800.00
Other Charges: 0.00
Total: 5650.50
Balance: 0.00 Paid: 5650.50
Rupees Five Thousand Six Hundred Fifty and Fifty Paise only

BY CASH For SRL Diagnostics Ltd.

Report Delivery Charges _______ Report can be collected on 27/08/2017 7:30 PM

Authorised Signatory

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