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LOHCHAB ULTRASOUND & X-RAY CENTER RAMGHAT ROAD, ALIGARH-202 001 PH: 2742755, 2743955

A center for Infertility & Maternity care with Facility of Laparoscopy, Hysteroscopy, Sonography & Color Doppler

No. 534 Dated:......................

Received with thanks from Mr./Mrs.........................................................................................................


the sum of Rs. (in words)............................................................................................Rs...........................
on account of ............................................................................................................................................

Signature

LOHCHAB ULTRASOUND & X-RAY CENTER RAMGHAT ROAD, ALIGARH-202 001 PH: 2742755, 2743955
A center for Infertility & Maternity care with Facility of Laparoscopy, Hysteroscopy, Sonography & Color Doppler

No. 1011 Dated:......................

Received with thanks from Mr./Mrs.........................................................................................................


the sum of Rs. (in words)............................................................................................Rs...........................
on account of ............................................................................................................................................

Signature

LOHCHAB ULTRASOUND & X-RAY CENTER RAMGHAT ROAD, ALIGARH-202 001 PH: 2742755, 2743955
A center for Infertility & Maternity care with Facility of Laparoscopy, Hysteroscopy, Sonography & Color Doppler

No Dated:......................

Received with thanks from Mr./Mrs.........................................................................................................


the sum of Rs. (in words)............................................................................................Rs...........................
on account of ............................................................................................................................................

Signature
LOHCHAB NURSING HOME
RAMGHAT ROAD, ALIGARH-202 001 PH: 2743755

No. 11845 Dated:......................

Received with thanks from Mr./Mrs............................................................................................


W/o .............................................................................................................................................
the sum of Rs. (in words).............................................................................................................
................................................................................................................Rs.................................
on account of ..............................................................................................................................
Ref. by Dr.....................................................................................................................................
Sample I D – ALG/______________________ Signature

LOHCHAB NURSING HOME


RAMGHAT ROAD, ALIGARH-202 001 PH: 2743755

No. 11845 Dated:......................

Received with thanks from Mr./Mrs............................................................................................


W/o .............................................................................................................................................
the sum of Rs. (in words).............................................................................................................
................................................................................................................Rs.................................
on account of ..............................................................................................................................
Ref. by Dr.....................................................................................................................................
Sample I D – ALG/______________________ Signature
CASE MEMO/BILL Phone: 2743955

LOHCHAB NURSING HOME


Kishan Pur Tiraha, Ramghat Road, ALIGARH

No. 3612 Dated:...........................

Patients Mr./Mrs...............................................................................................................
W/o ..................................................................................................................................
Address ............................................................................................................................
..........................................................................................................................................
D.O.A............................................D.O.D.....................................Bed No.......................
Total Days .........................................................................Adm.No................................
Amount
Sl. PARTICULARS
Rs. P.
1. Admission Charges
2. Room Rent
3. Specialist Charges
4. Physician
5. Delivery/Operation Fee
6. O.T. Charge
7. Aneasthetist
8. Asst. Charge
9. Paediatrician Charge
10. I.V./Blood Transformation
11. Nursing Care
12. Dressings
13. Oxygen
14. Dr's Visit
15. C.T.G.
16. Misc.

Advance Total

Total Rupees.........................................................................................................
Received with thanks ...........................................................................................
E.&.O.E. Signature