PAN No.

AABCA3631R Bill of Supply(Final Bill) CIN No : U85110DL1997PLC088209

GSTIN : 06AABCA3631R2Z1 State Code : 06

MR No : 493100 State : Haryana

IP.No. : 185724 Bill No. : I/19-20/S8016214

Patient Name : MR. SHYAM Bill Date : 05-Sep-2019

Age/Sex : 25 YRS / MALE FATHER : MR KAILASH SHARMA

Address : H NO-B 909. ASPLATINUM Unit : Dr. Sumant Gupta/Dr. Arjun Chib
FARIDABAD FARIDABAD
FARIDABAD INDIA

Admit RoomType Admission Date & Time Discharge Type Discharge RoomType Discharge Date & Time
Multi Sharing ( General 21-Aug-2019 3:29 pm BMT-ROOM--Isolation-BM
NORMAL DISCHARGED 05-Sep-2019 5:16:00PM
Ward )--Kanta T--3
Wing-GW-3035

Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.

1. ROOM CHARGES

21-Aug-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

22-Aug-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

23-Aug-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

24-Aug-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

25-Aug-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

26-Aug-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

27-Aug-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

28-Aug-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

29-Aug-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

30-Aug-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

31-Aug-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

1-Sep-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

03-Apr-2021 5:36 pm Page 1 of 10

 IP. No. ISHHI185724 Bill No. : I/19-20/S8016214

Patient Name MR. SHYAM Age : 25 YRS MALE

Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.

2-Sep-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

3-Sep-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

4-Sep-19 MULTI SHARING ( GENERAL WARD ) 999311 3,700.00 1.00 0.00 3,700.00

Total : 0.00 55,500.00

2. IPD CONSULTATION

21-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

22-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
22-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

23-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
23-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

24-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
24-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

25-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
25-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

26-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
26-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

27-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
27-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

28-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
28-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

03-Apr-2021 5:36 pm Page 2 of 10

 IP. No. ISHHI185724 Bill No. : I/19-20/S8016214

Patient Name MR. SHYAM Age : 25 YRS MALE

Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.

29-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
29-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

30-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
30-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1,600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

31-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
31-Aug-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
31-Aug-19 DR. BHASKAR/BIR SINGH/SHASHANK 1, 600.00 1.00 0.00 1, 600.00
(GASTROENTEROLOGY)

1-Sep-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
1-Sep-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

2-Sep-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
2-Sep-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
2-Sep-19 DR. BHASKAR/BIR SINGH/SHASHANK 1, 600.00 1.00 0.00 1, 600.00
(GASTROENTEROLOGY)

3-Sep-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
3-Sep-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

4-Sep-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)
4-Sep-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

5-Sep-19 DR. SUMANT GUPTA/DR. ARJUN CHIB 1, 600.00 1.00 0.00 1, 600.00
(ONCOLOGY)

Total : 0.00 51,200.00

3. ONCOLOGY LAB

03-Apr-2021 5:36 pm Page 3 of 10

 IP. No. ISHHI185724 Bill No. : I/19-20/S8016214

Patient Name MR. SHYAM Age : 25 YRS MALE

Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.

27-Aug-19 CHEMOTHERAPHY MULTIPLE DRUG 999311 5,310.00 1.00 0.00 5,310.00

INFUSIONAL (MO112)

29-Aug-19 CHEMOTHERAPHY MULTIPLE DRUG 999311 5,310.00 1.00 0.00 5,310.00

INFUSIONAL (MO112)

Total : 0.00 10,620.00

4. PROCEDURE CHARGES

21-Aug-19 NEBULISATION (CMP154) 999311 80.00 2.00 0.00 160.00

22-Aug-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

23-Aug-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

23-Aug-19 BLOOD TRANSFUSION BB117 999311 400.00 1.00 0.00 400.00

24-Aug-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

25-Aug-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

26-Aug-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

27-Aug-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

28-Aug-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

29-Aug-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

29-Aug-19 LUMBAR PUNCTURE CMP143 999311 2,530.00 1.00 0.00 2,530.00
29-Aug-19 BLOOD TRANSFUSION BB117 999311 400.00 1.00 0.00 400.00

30-Aug-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

31-Aug-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

1-Sep-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

2-Sep-19 BLOOD TRANSFUSION (BB117) 999311 400.00 1.00 0.00 400.00

2-Sep-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

3-Sep-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

03-Apr-2021 5:36 pm Page 4 of 10

 IP. No. ISHHI185724 Bill No. : I/19-20/S8016214

Patient Name MR. SHYAM Age : 25 YRS MALE

Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.

4-Sep-19 NEBULISATION (CMP154) 999311 80.00 3.00 0.00 240.00

5-Sep-19 NEBULISATION (CMP154) 999311 80.00 1.00 0.00 80.00

Total : 0.00 7,330.00

5. PATHOLOGY

21-Aug-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 1.00 0.00 110.00
(LB426)

22-Aug-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 1.00 0.00 110.00
(LB426)

23-Aug-19 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00

23-Aug-19 POTASSIUM (K+) (LB450) 999311 220.00 1.00 0.00 220.00
23-Aug-19 BILIRUBIN, SERUM (LB441) 999311 400.00 1.00 0.00 400.00
23-Aug-19 CREATININE, SERUM (LB444) 999311 210.00 1.00 0.00 210.00
23-Aug-19 URIC ACID,SERUM (LB458) 999311 360.00 1.00 0.00 360.00
23-Aug-19 BLOOD GROUPING & RH (LB574) 999311 110.00 1.00 0.00 110.00
23-Aug-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)

24-Aug-19 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00

24-Aug-19 BLOOD SUGAR RANDOM (LB425) 999311 110.00 2.00 0.00 220.00

25-Aug-19 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00

25-Aug-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)

26-Aug-19 ELECTROLYTES (LB247) 999311 360.00 1.00 0.00 360.00

26-Aug-19 LFT- II (BILIRUBIN + SGOT + SGPT + 999311 700.00 1.00 0.00 700.00
ALKANINE PHOSPHATASE + TOTAL
PROTEIN + ALBUMIN + GLOBULIN)
(LB349)
26-Aug-19 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00
26-Aug-19 PERIPHERAL SMEAR FOR TYPE OF 999311 640.00 1.00 0.00 640.00
ANAEMIA OR ABNORMAL CELLS (PS
FOR TOA) (LB616)
26-Aug-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)

27-Aug-19 BILIRUBIN, SERUM (LB441) 999311 400.00 1.00 0.00 400.00

03-Apr-2021 5:36 pm Page 5 of 10

 IP. No. ISHHI185724 Bill No. : I/19-20/S8016214

Patient Name MR. SHYAM Age : 25 YRS MALE

Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.

27-Aug-19 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00

27-Aug-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)

28-Aug-19 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00

28-Aug-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 1.00 0.00 110.00
(LB426)

29-Aug-19 ELECTROLYTES (LB247) 999311 360.00 1.00 0.00 360.00

29-Aug-19 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00
29-Aug-19 BILIRUBIN, SERUM (LB441) 999311 400.00 1.00 0.00 400.00
29-Aug-19 CREATININE, SERUM (LB444) 999311 210.00 1.00 0.00 210.00
29-Aug-19 CSF CYTOLOGY & BIOCHEMISTRY 999311 600.00 1.00 0.00 600.00
(LB232)
29-Aug-19 BODY FLUID FOR MALIGNANT CELLS 999311 790.00 1.00 0.00 790.00
(LB555)
29-Aug-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 1.00 0.00 110.00
(LB426)

30-Aug-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)

31-Aug-19 LFT- II (BILIRUBIN + SGOT + SGPT + 999311 700.00 1.00 0.00 700.00
ALKANINE PHOSPHATASE + TOTAL
PROTEIN + ALBUMIN + GLOBULIN)
(LB349)
31-Aug-19 RFT- III (LB430) 999311 1,300.00 1.00 0.00 1,300.00
31-Aug-19 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00
31-Aug-19 LIPASE (LB352) 999311 700.00 1.00 0.00 700.00
31-Aug-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)

1-Sep-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)

2-Sep-19 PROCALCITONIN(PCT) (LB401) 999311 3,080.00 1.00 0.00 3,080.00

2-Sep-19 ELECTROLYTES (LB247) 999311 360.00 1.00 0.00 360.00
2-Sep-19 LIPASE (LB352) 999311 700.00 1.00 0.00 700.00
2-Sep-19 BILIRUBIN, SERUM (LB441) 999311 400.00 1.00 0.00 400.00
2-Sep-19 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00
2-Sep-19 PERIPHERAL SMEAR FOR TYPE OF 999311 640.00 1.00 0.00 640.00
ANAEMIA OR ABNORMAL CELLS (PS
FOR TOA) (LB616)

03-Apr-2021 5:36 pm Page 6 of 10

 IP. No. ISHHI185724 Bill No. : I/19-20/S8016214

Patient Name MR. SHYAM Age : 25 YRS MALE

Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.

2-Sep-19 PT (PROTHROMBIN TIME) (LB618) 999311 430.00 1.00 0.00 430.00

2-Sep-19 *ANTI-HCV BY ECLIA (LB864) 999311 790.00 1.00 0.00 790.00
2-Sep-19 *HBSAG BY ECLIA (LB863) 999311 750.00 1.00 0.00 750.00
2-Sep-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)

3-Sep-19 ELECTROLYTES (LB247) 999311 360.00 1.00 0.00 360.00

3-Sep-19 BILIRUBIN, SERUM (LB441) 999311 400.00 1.00 0.00 400.00
3-Sep-19 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00
3-Sep-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)

4-Sep-19 ELECTROLYTES (LB247) 999311 360.00 1.00 0.00 360.00

4-Sep-19 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00
4-Sep-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 2.00 0.00 220.00
(LB426)

5-Sep-19 ELECTROLYTES (LB247) 999311 360.00 1.00 0.00 360.00

5-Sep-19 BILIRUBIN, SERUM (LB441) 999311 400.00 1.00 0.00 400.00
5-Sep-19 CBC (HAEMOGRAM) (LB578) 999311 470.00 1.00 0.00 470.00
5-Sep-19 BLOOD SUGAR RANDOM(BY REFLO) 999311 110.00 1.00 0.00 110.00
(LB426)

Total : 0.00 26,100.00

6. RADIOLOGY

31-Aug-19 ULTRASOUND WHOLE ABDOMEN 999311 1,650.00 1.00 0.00 1,650.00

(RD415)
31-Aug-19 X RAY ABDOMEN ERRECT POSITION 999311 480.00 1.00 0.00 480.00
(RD424)

Total : 0.00 2,130.00

7. BLOOD BANK

23-Aug-19 PRBC PROCESSING/TESTING CHARGES 999311 1,500.00 1.00 0.00 1,500.00

(BB109)

25-Aug-19 MEGA PLATELETS APHERESIS 999311 11,000.00 1.00 0.00 11,000.00

PROCESSING/TESTING CHARGES
(BB108)
25-Aug-19 PRBC PROCESSING/TESTING CHARGES 999311 1,500.00 1.00 0.00 1,500.00
(BB109)

03-Apr-2021 5:36 pm Page 7 of 10

 IP. No. ISHHI185724 Bill No. : I/19-20/S8016214

Patient Name MR. SHYAM Age : 25 YRS MALE

Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.

2-Sep-19 PRBC PROCESSING/TESTING CHARGES 999311 1,500.00 1.00 0.00 1,500.00

(BB109)

Total : 0.00 15,500.00

8. BLOOD BANK SERVICES

25-Aug-19 PLATELET TRANSFUSION BB113 999311 420.00 1.00 0.00 420.00

29-Aug-19 PLATELET TRANSFUSION BB113 999311 420.00 1.00 0.00 420.00

Total : 0.00 840.00

9. MEDICINE & CONSUMABLES

21-Aug-19 SARVODAYA HOSPITAL & RESEARCH 999311 2,411.09 1.00 0.00 2,411.09
CENTER UNIT II

22-Aug-19 SARVODAYA HOSPITAL & RESEARCH 999311 291.83 1.00 0.00 291.83
CENTER UNIT II

23-Aug-19 SARVODAYA HOSPITAL & RESEARCH 999311 913.97 1.00 0.00 913.97
CENTER UNIT II

24-Aug-19 SARVODAYA HOSPITAL & RESEARCH 999311 53.70 1.00 0.00 53.70
CENTER UNIT II

25-Aug-19 SARVODAYA HOSPITAL & RESEARCH 999311 1,752.85 1.00 0.00 1,752.85
CENTER UNIT II

26-Aug-19 SARVODAYA HOSPITAL & RESEARCH 999311 1,073.93 1.00 0.00 1,073.93
CENTER UNIT II

27-Aug-19 SARVODAYA HOSPITAL & RESEARCH 999311 5,222.10 1.00 0.00 5,222.10
CENTER UNIT II

28-Aug-19 SARVODAYA HOSPITAL & RESEARCH 999311 1,000.96 1.00 0.00 1,000.96
CENTER UNIT II

29-Aug-19 SARVODAYA HOSPITAL & RESEARCH 999311 237.75 1.00 0.00 237.75
CENTER UNIT II

30-Aug-19 SARVODAYA HOSPITAL & RESEARCH 999311 2,754.80 1.00 0.00 2,754.80
CENTER UNIT II

31-Aug-19 SARVODAYA HOSPITAL & RESEARCH 999311 1,880.72 1.00 0.00 1,880.72
CENTER UNIT II

03-Apr-2021 5:36 pm Page 8 of 10

 IP. No. ISHHI185724 Bill No. : I/19-20/S8016214

Patient Name MR. SHYAM Age : 25 YRS MALE

Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.

1-Sep-19 SARVODAYA HOSPITAL & RESEARCH 999311 2,401.93 1.00 0.00 2,401.93
CENTER UNIT II

2-Sep-19 SARVODAYA HOSPITAL & RESEARCH 999311 3,498.47 1.00 0.00 3,498.47
CENTER UNIT II

3-Sep-19 SARVODAYA HOSPITAL & RESEARCH 999311 6,426.11 1.00 0.00 6,426.11
CENTER UNIT II

4-Sep-19 SARVODAYA HOSPITAL & RESEARCH 999311 5,607.06 1.00 0.00 5,607.06
CENTER UNIT II

5-Sep-19 SARVODAYA HOSPITAL & RESEARCH 999311 -1,881.91 1.00 0.00 -1,881.91
CENTER UNIT II

Total : 0.00 33,645.36

Net Total : 202,865.00

Amount Received : ( - ) 202,865.00

Net Amount : 0.00

RUPEES ZERO ONLY

WIN OVER CANCER

E & OE

Policy No : .
Card No : . File No : .
Card Holder : . Relation with Card Holder : SELF
TPA Remarks :

Receipt/Refund No. Date Amount (Rs.) Receiver

CASH F/19-20/S8151321 (Receipt) 05-Sep-2019 67,000.00 Mr. Tejpal Singh 14476
CR CARD F/19-20/S8151324 (Receipt) 05-Sep-2019 80,000.00 Mr. Tejpal Singh 14476

CHEQUE F/19-20/S8187879 (Receipt) 06-Nov-2019 55,865.00 Miss. Sheetal

03-Apr-2021 5:36 pm Page 9 of 10

 IP. No. ISHHI185724 Bill No. : I/19-20/S8016214

Patient Name MR. SHYAM Age : 25 YRS MALE

Date Particulars SAC Code Rate Nos. Disc Net Amt Rs.

Patient's / Attendent's Signature Authorised Signature

( Tejpal Singh 14476 )

03-Apr-2021 5:36 pm Page 10 of 10