FINAL BILL

Sahyadri Narayana Multispeciality Hospital, Shimoga- IP BILLING 2F

Village Harkere, Near Shankar Nethralaya Hospital, New Thirthalli Road, Shimoga, , Karnataka, India

Patient Name : Kavitha B N (female|61y 7m|03/14/1962) Bill No : IB100923L001333

Patient MRN : 10090000371436 Date : 26-10-2023 07:05 PM
Patient Phone No : 8749033647 Tariff Class : Semi Special
Address : Kallihal, Shivamogga, Shimoga, Admitted Under : Dr. S Sumesh Nair
Karnataka, India, 577233 Visit No : IP-001
Admission Date : 16-10-2023 01:38 PM
Discharge Date : 26-10-2023 12:20 PM
Ward/Bed : SEMI SPECIAL-WARD-2F / 2F-SSW-210-C

Particulars Date Qty Unit Rate Amount Total Amt (Rs)

Administrative
960.00
Bed Charges
21,000.00
Consultation
17,360.00
Hospitalisation and Care
27,900.00
Laboratory Services
30,120.00
Procedures
3,110.00
Radiology
16,190.00
MEDICINES
15,888.10
SURGICAL CONSUMABLES
11,272.10

Total Hospital Charges for Rendered Services/Items : 143,800.20

Discount - Patient: 9,254.27, Sponsor:0.00 Less Discount : 9,254.27
GSTIN: 29AABCN1685J1Z4 Total Bill Amount Including Taxes before round off : 134,545.93
Sponsor Payable : 0.00
Patient Round Off : 0.07
Patient Payable : 134,546.00
Amount in words: Rupees One Lakh Thirty Four Thousand Five Hundred Forty Six Only
Total savings: Rs. 9,254.27

Receipt No. Date Receipt Amount Adjusted Amount

1. RCPI-1009-2312001468 16-12-2023 01:48 PM 10,000.00 10,000.00
2. RCPI-1009-2312001769 19-12-2023 07:25 PM 5,000.00 5,000.00
3. RCPI-1009-2312001952 21-12-2023 07:45 PM 10,000.00 10,000.00
4. RCPI-1009-2312002343 26-12-2023 07:04 PM 109,456.00 109,456.00
5. RCPI-1009-2312002344 26-12-2023 07:05 PM 90.00 90.00
Total 134,546.00

Balance Details
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Patient Name : Kavitha B N (10090000371436)
Bill No : IB100923L001333

Gross bill amount : 143,800.20

Less Discount : 9,254.27
Sponsor Amount : 0.00
Net Amount : 134,546.00
Amount Paid : 134,546.00
Balance To Pay : 0.00

NOTE:
As per existing notifications, circulars and clarifications provided by the Authorities, Healthcare Services are exempt from Goods and Services Tax. Accordingly,
we confirm that no Goods and Services tax has been charged or collected in this invoice.

Prepared By: Sharath T G, 333850 | Prepared On 26-10-2023 19:05 |

Published By: Sushma Y, 340125 | Published On: 26-10-2023 23:27 |

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