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Bill of Supply (Final Bill) : MR No State Code State Gstin
Bill of Supply (Final Bill) : MR No State Code State Gstin
Admit RoomType Admission Date & Time Discharge Type Discharge RoomType Discharge Date & Time
Multi Sharing ( General 21-Dec-2020 3:29pm BMT-ROOM--Isolation-BM
NORMAL DISCHARGED 05-Jan-2021 5:16:00PM
Ward )--Kanta T--3
Wing-GW-3035
Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.
1. ROOM CHARGES
21-Dec-20 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
22-Dec-20 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
23-Dec-20 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
24-Dec-20 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
25-Dec-20 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
26-Dec-20 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
27-Dec-20 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
28-Dec-20 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
29-Dec-20 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
30-Dec-20 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
31-Dec-20 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
1-jan-21 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.
2-jan-21 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
3-jan-21 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
4-jan-21 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00
22-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
22-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
23-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
23-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
24-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
24-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
25-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
25-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
26-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
26-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
27-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
27-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
28-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
28-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.
29-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
29-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
30-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
30-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1,600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
31-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
31-Dec-20 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
31-Dec-20 DR. BHASKAR/BIR SINGH/SHASHANK 1, 600.00 1.00 0.00 1, 600.00
(GASTROENTEROLOGY)
1-Jan-21 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
1-Jan-21 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
2-Jan-21 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
2-Jan-21 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
2-Jan-21 DR. BHASKAR/BIR SINGH/SHASHANK 1, 600.00 1.00 0.00 1, 600.00
(GASTROENTEROLOGY)
3-Jan-21 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
3-Jan-21 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
4-Jan-21 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
4-Jan-21 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
5-Jan-21 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.
27-Dec-20 CHEMOTHERAPHY MULTIPLE DRUG 999311 5,310.00 1.00 0.00 5,310.00
INFUSIONAL (MO112)
Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.
4-Jan-21 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00
21-Dec-20 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 1.00 0.00 110.00
(LB426)
22-Dec-20 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 1.00 0.00 110.00
(LB426)
Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.
27-Dec-20 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00
27-Dec-20 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)
30-Dec-20 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)
31-Dec-20 LFT- II (BILIRUBIN + SGOT + SGPT + 999311 700.00 1.00 0.00 700.00
ALKANINE PHOSPHATASE + TOTAL
PROTEIN + ALBUMIN + GLOBULIN)
(LB349)
31-Dec-20 RFT- III (LB430) 999311 1,300.00 1.00 0.00 1,300.00
31-Dec-20 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00
31-Dec-20 LIPASE (LB352) 999311 700.00 1.00 0.00 700.00
31-Dec-20 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)
1-Jan-21 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)
Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.
2-Jan-21 PT (PROTHROMBIN TIME) (LB618) 999311 430.00 1.00 0.00 430.00
2-Jan-21 *ANTI-HCV BY ECLIA (LB864) 999311 790.00 1.00 0.00 790.00
2-Jan-21 *HBSAG BY ECLIA (LB863) 999311 750.00 1.00 0.00 750.00
2-Jan-21 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)
Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.
2-Jan-21 PRBC PROCESSING/TESTING CHARGES 999311 1,500.00 1.00 0.00 1,500.00
(BB109)
21-Dec-20 SARVODAYA HOSPITAL & RESEARCH 999311 2,411.09 1.00 0.00 2,411.09
CENTER UNIT II
22-Dec-20 SARVODAYA HOSPITAL & RESEARCH 999311 291.83 1.00 0.00 291.83
CENTER UNIT II
23-Dec-20 SARVODAYA HOSPITAL & RESEARCH 999311 913.97 1.00 0.00 913.97
CENTER UNIT II
24-Dec-20 SARVODAYA HOSPITAL & RESEARCH 999311 53.70 1.00 0.00 53.70
CENTER UNIT II
25-Dec-20 SARVODAYA HOSPITAL & RESEARCH 999311 1,752.85 1.00 0.00 1,752.85
CENTER UNIT II
26-Dec-20 SARVODAYA HOSPITAL & RESEARCH 999311 1,073.93 1.00 0.00 1,073.93
CENTER UNIT II
27-Dec-20 SARVODAYA HOSPITAL & RESEARCH 999311 5,222.10 1.00 0.00 5,222.10
CENTER UNIT II
28-Dec-20 SARVODAYA HOSPITAL & RESEARCH 999311 1,000.96 1.00 0.00 1,000.96
CENTER UNIT II
29-Dec-20 SARVODAYA HOSPITAL & RESEARCH 999311 237.75 1.00 0.00 237.75
CENTER UNIT II
30-Dec-20 SARVODAYA HOSPITAL & RESEARCH 999311 2,754.80 1.00 0.00 2,754.80
CENTER UNIT II
31-Dec-20 SARVODAYA HOSPITAL & RESEARCH 999311 1,880.72 1.00 0.00 1,880.72
CENTER UNIT II
Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.
1-Jan-21 SARVODAYA HOSPITAL & RESEARCH 999311 2,401.93 1.00 0.00 2,401.93
CENTER UNIT II
2-Jan-21 SARVODAYA HOSPITAL & RESEARCH 999311 3,498.47 1.00 0.00 3,498.47
CENTER UNIT II
3-Jan-21 SARVODAYA HOSPITAL & RESEARCH 999311 6,426.11 1.00 0.00 6,426.11
CENTER UNIT II
4-Jan-21 SARVODAYA HOSPITAL & RESEARCH 999311 5,607.06 1.00 0.00 5,607.06
CENTER UNIT II
5-Jan-21 SARVODAYA HOSPITAL & RESEARCH 999311 -1,881.91 1.00 0.00 -1,881.91
CENTER UNIT II
Policy No : .
Card No : . File No : .
Card Holder : . Relation with Card Holder : SELF
TPA Remarks :
Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.