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