FINAL BILL

Dharamshila Narayana Superspeciality Hospital- ONCOLOGY OPD AREA-

GF-BLOCK-A
VASUNDHRA ENCLAVE, NEAR NEW ASHOK NAGAR METRO STATION, New Delhi, Delhi, India
-110096

Patient Name : Mrs Munni Thapliyal Bill No : IB150523J002605

Patient MRN : 15050000114320 Date : 21-10-2023 12:47 PM
Gender|Age|DoB : female|64y 11m|10/11/58 Tariff Class : OPD
Patient Phone No : 9810227496 Admitted Under : Dr Prahladprasadagrawal
Address : H NO 214-215 BLOCK 10 KHICHRIPUR , New Delhi, Visit No : ER-003
Delhi, India, 110091 Admission Date : 21-10-2023 10:18 AM
Discharge Date : 21-10-2023 12:41 PM
Ward/Bed : EMERGENCY WARD-GF-BLOCK-B / 7

Plan: 1505_CGHS14(NABH)_CREDIT_PARENT |
Sponsor : CENTRAL GOVT HEALTH SCHEME (CENTRAL GOVT HEALTH SCHEME, 1329_C) |Sponsor Bill No : SB150523J001572 | Sponsor Payable : 1,082.22
Particulars Date Qty MRP Unit Rate Amount (Rs)
Administrative
1. I/D Injection Keloid (CGHS - 28) 21-10-2023 1 112.00 112.00
Total 112.00
Consultation
1. EMERGENCY CONSULTATION CHARGE 21-10-2023 1 350.00 350.00
Total 350.00
Diagnostics Non-Lab
1. ECG (CGHS code:590) 21-10-2023 1 175.00 175.00
Total 175.00
Laboratory Services
1. Blood Glucose Random( CGHS Code No. 1444) 21-10-2023 1 28.00 28.00
Total 28.00
MEDICINES
1. CLONAZEPAM-TABLET-0.5MG-CLONOTRIL- |2JC6K006 / 2025-11-30 (30049082) 21-10-2023 1 3.48 3.48 3.48
2. PANTOPRAZOLE-INJECTION-40MG-ZOVANTA- |PPQDA52 / 2024-11-30 (30049039) 21-10-2023 1 55.04 55.04 55.04
3. ONDANSETRON-INJECTION-8MG/4ML-PERISET- |EWI023002D / 2025-05-31 21-10-2023 1 26.70 26.70 26.70
(30049035)
Total 85.22
SURGICAL CONSUMABLES
1. I V CANNULA-.-22G-ULTRA 1201 POLYMED- |4118423G / 2028-06-30 (90183920) 21-10-2023 1 185.00 185.00 185.00
2. TRANSPARENT ADHESIVE DRESSING-P0675P W/O PAD PLAIN-6CM X 7.5CM- 21-10-2023 1 147.00 147.00 147.00
RELIDERM I.V GUJARAT HEALTH CARE- |239018 / 2026-08-31 (30059040)
Total 332.00

Total Hospital Charges for Rendered Services/Items : 1,082.22

GSTIN: 07AAATD0451G1Z7 Total Bill Amount Including Taxes before round off : 1,082.22
Sponsor Payable : 1,082.22
Patient Round Off : 0.00
Patient Payable : 0.00
Amount in words: Rupees Zero Only

Balance Details
Gross bill amount : 1,082.22
Less Discount : 0.00
Sponsor Amount : 1,082.22
Net Amount : 0.00
Amount Paid : 0.00
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Patient Name :Mrs Munni Thapliyal (15050000114320)
Bill No : IB150523J002605

Balance To Pay : 0.00

Prepared By: Vishal ., 367522 | Prepared On: 21-10-2023 12:47 | Scan to download NH Care app
Published By: Administrator, admin | Published On: 21-10-2023 12:47 | Access your Lab reports,
prescription and book appointment

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