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ETERNAL
ETERNAL #A
NIount
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HOSPITAL
'ild;d#MFai HOSPITAL Sinai
Heart
,=(
GSTIN: 08AACCB0S60ATZB
**:f FINAL BlLL ***
PATTENT DETAILS

Name : MR, RAJEEV UDAIWAT

Age / Sex : 47Y/M Et!!
UHID
Number :tPB.2O79i4487
: EHe-00156897
Payer Date :26/o7l21ts
: MR" RAJEEV UDAIWAL
Address : 20 2l SWAMI LEELA SHAH
COLONY SANGANER,
JAIPUR,
RAJASTHAN,
Telephone : 9829049 406.
ADMISSION DETAILS
IPID
tP-60702 DISCHARGE
Date/Time Date/Time
24107l2ltg 10:45 261o7/21tg
Admitted Under Bed/Room t4:43
Dr. LOKESH iAlN 577-8 - FIFTH FLOOR -
Company Discharge Type C WING
MR. RAJEEV UDAIWAT NORMAL DISCHARGE
lnsurance Company Ticket No
NA NA
Treating Consultant
1; __

Treating Consuttant Reference No :NA

2: __

company : MR. RAJEEV uDAlwAL

lnsurance Company
:NA
particutars
Date
Bed Charges Qtv Amount Discount Net Amount
SEMI DELUXE ROOM
SEMI DELUXE ROOM
24/07/201s 24/07/2OLs
4,000.00
2s/07/207s 2s/ot/21ts 1 4,000.00
4,000.00
4,000.00 t 4,000.00
4,000.00
Admission Charges
I 8,000.00
8,000.00
1000.00
1,000.00
< 1,000.00
1,000.00
Pathology lnvestigations
cBC (coMPrETE BLOoD
COUNT)
24/O7/20L9 - 7777
PT (PROTHROMBINE 400.00
TIME) 1
24/O7/2OL} - 400.00
7717 400.00
RENAL PROFI[E TEST 450.00 1 450.00
24/07/2079 _ 1777 4s0.00
l_FT (UVER FUNCTtoN 900.00
TEST) 1 900.00
24/O7/2oLg _ 7777 900.00
AMYI.ASE 1,100.00
1.
24/07/zOLg _ 1777 1,100.00
I.IPASE
1,100.00
550.00 7
24/O7/2oLg _ 7717 s50.00
BLOOD 5s0.00
GrucosE (RANDOM) 800.00 1
24/07/2019 _ 1177 800.00
CALCIUM TOTAL 800.00
150.00 1
24/07/2oLg _ 7347 1s0.00
LIPID PROFILE 150.00
250.00 7
24/07/207s _ 734L 250.00
pTH (intact) .2s0.00
900.00 1
24/07/207s - 900.00
cBc (coMPLETE 7347 900.00
BLOOD couNT) 7,730.oo
1 7,730.00
25/07/2otg - 0606 'soo.0o 7,730.00
AMYLASE
L s00.00
2s/o7/2OLs _ 0606 500.00
LIPASE 688.00 L 688.00
2s/07/20L9 _ 0606 688.00
GLUCOSE TEST (GLUCO 1,000.00
METER) 1 1,000.00
26/07/207s - L238 1,000.00
100,00 1 100.00
100.00
Radiology lnvestigations t 9,s18.00
9,518.00
X. RAY ABDOMEN ERECT
AP VIEW (SINGLE
EXPOSURE) 24/07/2019 - 77s7
3s0.00
X RAY CHESTAP VIEW 3s0.00
3s0.00
24/07/201s - 17s1 350.00
E.& o.E. 3s0.00
350.00

Page 1 of4
3A, Near Jawahar Circle, Jaipur - 302017, Rajasthan (lndia)
Phone : +91-1 41-5174000, 2774A00, Website : www.eternalhospital.com
CIN No. UBs1 1 0RJ2007PTC02365S
 GSTIN: 08AACCE0560AIZB
*** FINAL BILL ***
PATIENT DE{AI$
Name : MR. RATEEV UDATWAL Bttt
Agel Sex : 47ylM Number .trl8207g/,4481
UHID : EHC-00156897 Date i 26l17l21tg
Payer : MR. RATEEV UDAIWAI
Treating Consultant 1: __
Reference No : NA
Treating Consuttant 2: -- lnsurance Company ; g4
Company : MR. RAJEEV UDAIWAL

Particulars
Date Rate Qty Amount Discount Net Amount
usc wHoLE ABDOMEN(LOWER & UPPER) 24/O7/2Ot9 - tlsl 1,500.00 7 1,500.00
CT WHOTE ABDOMEN (CONTRAST
STUDY) 1,500.00
2s/o7/2019 -O9Oo 10,625.00 t 10,625.00 10,625.00

Drugs & Consumable from Store { 12,825.00 t2,a25.OO

Batch No Expiry Date

IV CANNULA (VENFLON l) NO. IPD PHARMACY 24/07/2019 83O6s77 3t/7o/2)23
18G ( BD) 195.00 1 195.00 195.00
POSIFLUSH SP lOML REF BDP1O IPD PHARMACY 24/07/2019 91t7s4o
(BD tNDtA) 3t/12/2O27 42.OO 1 42.00 42.OO
QSYTE BI EXTENSION (BD) IPDPHARMACY 241O7/20L9 8183748 30/06/2027 3s6.00 1 3s6.00
IVSET LUER IOCK NON VENTED 356.00
(KPM HEALTHCARE)
IPD PHARMACY 24/07/2079 1807031 3o/o6/202t 140.00 1 140.00 140.00
SYRINGE OMNIVAN WITH NEEDLE IPD
PHARMACY 24/07/2019 19D03M820 37/03/2024
2ML (B BMUN) 10.00 1 10.00
2 10.00
SYRINGE OMNIVAN WITH NEEDLE IPD
PHARMACY 24/07/2019 19D12M820 3r/03/2024
10Mr (B BRAUN) 22.OO 2 44.00
2 44.OO
SKIN BLADE TRIMMER (ROMSONS) IPD PHARMACY
24/07/2019 G19o11oO1 37/L2/2023
LEUKOMED IV FIIM 6X8 (IV 52.00 t s2.00 52.00
IPD PHARMACY 24/O7120L9 84270832 3ol}s/2023
CANNUTA FIXATOR) BSN MEDICAL L2L.O0 1 12r.00 121.00
SYRINGE EMERALD WITH NEEDLE IPD PHARMACY 24/07/207918J1981 3r/08/2023 15.50
sML (BD) 1 15.50 15.50
IV SET LUER LOCK NON VENTED IPD PHARMACY 24/07/2079 1807031
(KPM HEALTHCARE) 30106/202t 140.00 1 140.00 140.00
SYRINGE OMNIVAN WITH NEEDLE IPD PHARMACY
24/07/2019 19D12M82O 3t/o3/2}24
lOML (B BRAUN) 22.OO 1 22.00
2 22.OO
NEEDLE DISPOSABLE 16X1.5 IPD PHARMACY 24/O7/20L9 G37310 28/02/2023
(ROMSONS) 3.50 L 3.s0 3.50
SYRINGE WITH LUER LOCK 1OML IPD PHARMACY 24/07/20L990849s7 3t/O3/2024
(BD) 33.00 5 16s.00 165.00
IV SET VENTED WITH IUER LOCK IPD PHARMACY 24/07/2OL9 32274 28/02/2022
(ROMSONS) 115.00 2 230.00 230.00
rv sET LUER LOCK (ROMSONS) tpD PHARMACY 24/O7/2Ot9 s378L4 3L/03/2O23 138.00 2 276.00
SYRINGE OMNIVAN WITH NEEDLE IPD PHARMACY 276.00
24/07/2079 19D12M820 37/03/2024
1OML (B BRAUN) 22.OO 3 66.00
2 66.00
SYRINGE EMERALD WITH NEEDLE
sML (BD)
IPD PHARMACY 24/07/2019 18J1981. 37/08/2023 15.50 2 31.00 31.00
BatchNo ExpiryDate
PANSEC (PANTOPRAZOLE) 4OMG IPD PHARMACY 24/O7/20L9 AFM9OO6 3Lh2/2O20
rNJ (C|PLA) 46.80 1 46.80 46.80
EMESET (ONDANSETRON) 4ML INJ
(crPrA)
IPD PHARMACY 24/O7/2OL9 1690041 3t/ot/2o22 24.60 t 24.60 24.60
SUPRIDOL (TRAMADOL IPD PHARMACY 24/07/20L9 e49233
HYDROCHLORTE) 5OMG/2ML st/o3/202:- 22.80 L 22.80 22.80
(NEoN)
NS (Pt AST|C) sooMr (SKKL) TPDPHARMACY 24107/2OLg p19O3O3O1s 28/02/202L
29.47 1 29.47
DYNATROY.AQ (DICLOFENAC) TPDPHARMACY 24/07/2079 D1O558O 3O/Og/2o2O 29.47
T5MG 1ML tNJ (rROtKM) 27.66 2 55.32 55.32
RL (PLASIC) sooML (SKKL) IPDPHARMACY 24/O7l2O1g 1130081H 3LlOs/2022
TAZAgT
49.74 t 49.74 49.74
tpDpHARMACy 24/O7/2Otg c890234 3t/o3l2)2L
(P I PERACT tltN+TAZO BACTAM) 48L.4t L 48L.4L 48t.47
4.5GM tNJ (CtPLA)
TAZACT
(PIPERACtLLtN+TAZOBACTAM)
IPDPHARMACY 24107/20t9 c890234 3UO3/2027 48t.4L 3 L444.23 L,444.23
4.sGM tNJ (C|PLA)

E.& O.E.
Page 2 of 4
 GSTIN: 08AACCE0560AlZB
*** FINAL BltL **'ft
PATIENT DETA]LS

Name MR. RAJEEV UDAIWAT Bltt

Age / Sex 47YlM Number :aPB.207914481
UHlD EHC-001s6897 Date :26107/20L9
Payer MR. RAJEEV UDAIWAL
Treating Consultant 1:
- Reference No :NA
Treating Consultant 2: - lnsurance Company :NA
Company : MR. RAJEEV UDATWAL

Particulars Date Rate Qty Amount Discount Net Amount

PANSEC (PANTOPRAZOLE) 4OMG
rNJ (CrPtA)
IPD PHARMACY 24/07l2ot9 AFM9006 3Llt2/2O2O 46.80 2 93.60 93.60
EMESET (ONDANSETRON) 2ML INJ
(crPrA)
IPD PHARMACY 24/O7/2019 1690106 37/03/2022 72.8t 3 38.43 38.43
SUPRIDOL (TRAMADOL
HYDROCHLORTE) s0MG/2Mr
IPD PHARMACY 24/07/20ts 949237 3L/03/2O2t 22.80 3 68.40 68.40
(NEON)
TELMACT
(TELMISARTAN+CH LORTHALIDoN
IPD PHARMACY 24/O7/20ts 18181644 30/Lt/2O2o L2.67 15 190.05 190.05
E) 40MG 1X15TAB (GLENMARK)
NS (PIASTIC) 100M1 (vision) IPD PHARMACY 24107/2019 P190231009 3LlO7/2O2L L6.62 6 99.72 99.72
NS FREEFLEX 5OOML (FRESENIUS) IPD PHARMACY 24107/2019 82NE604601 30/O4/2o2L 77.42 2 154.84 L54.84
TAZACT
(Pl PE RACt LU N+TAZOBACTAM)
IPD PHARMACY 24/07/201s c890234 31/03/2O2L 481.4t 3 L444.23 L,444.23
4.5GM tNJ (C|PLA)
PANSEC (PANTOPRAZOLE) 4OMG
rNJ (C|PLA)
IPD PHARMACY 24/07/2OL9 AFM9006 3L/L2/2020 46.80 2 93.60 93.60
EMESET (ONDANSETRON) 2ML INJ
(crPr.A)
IPD PHARMACY 24/O7/2019 1690106 3L/03/2022 12.8t 3 38.43 38.43
SUPRIDOL (TRAMADOL
HYDROCHLORTE) 5oMG/2ML
IPD PHARMACY 24/07/20L9 949237 37/0312021 22.80 3 68.40 68.40
(NEON)
NS FREEFLEX 5OOML (FRESENIUS) IPD PHARMACY 24/07/2OL9 82NE604601 3O/O4/2027 77.42 4 309.68 309.68
NS (PLASTIC) 100M1 (vision) IPD PHARMACY 24/07/20L9 P190231009 3t/oL/202t t6.62 3 49.86 49.86
<6,712.6L 6,712.6L

Medicine Return BatchNo ExpiryDate

IV SET LUER LOCK NON VENTED IPD PHARMACY 26/07/2OLS 1807031 30/06/202t 140,00 1
(KPM HEALTHCARE) 140.00 140.00
IV SET LUER LOCK NON VENTED IPD PHARMACY 26107l2OLl 180703L 30/06/2021 140.00 1 140.00 140.00
(KPM HEALTHCARE)
rv sET LUER LOCK (ROMSONS) IPD PHARMACY 26/07/2OLl s37814 3L/0312023 138.00 ! 138.00 138.00
NS FREEFT-EX 500M1 (FRESENTUS) IPD PHARMACY 26107/20L( 82NE60460 30/04/202L 77.42 7 77.42 77.42
L
SYRINGE WITH LUER LOCK 1OML IPD PHARMACY 26/07l21ll 9084957 3LlO3/2024 33.00 3 99.00
(BD) 99.00
NS FREEFLEX sOOMt (FRESENIUS) IPD PHARMACY 26/07lzOL! 82NE60460 30/04/202L 77.42 2 L54.84 754.84
1
NS (PLASTIC) 100M1 (vision) IPD PHARMACY 26/07 /20L! P19023100 3L/Otl2o2L L6.62 6 99.72 99.72
9

t 848.98 r 848.98

Net Medicine Amount After Medicine Return 5863.63 0.00 5853.63

Consultation Charges
LOKESH JAIN 24/0712019 24/07/2019 1 8s0.00 850.00
LOKESH JAIN 2s/07/2019 2s/o7/2ots 1 850.00 850.00
LOKESH JAIN 2s/o7/2Ot9 2s/o7/2119 7 850.00 8s0.00
LOKESH JAIN 26/07/2019 26/07/201s L 850.00 850.00

< 3,400.00 0.00 3,400.00

E.& O.E.
Page 3 of 4
 GSTIN: 08AACCE0560A1ZB
:T** FTNAL BltL ***
PATIENT DE..eILs

Name MR. RNEEV UDAIWAT

Bil-t
Age / Sex 47YlM Number t1PB.201914481
UHID EHC-00156897 Date i 2610712079
Payer
MR. RAJEEV UDATWAL
Treating Consultant 1:
Reference No :NA
Treating Consultant 2: lnsurance Company :NA
Company : MR. RAJEEV UDAIWAL

Particulars
Date Rate qty Amount Discount Net Amount
HospitalCharges
DIETICIAN CHARGES
24/07/2019 200.00
200.00

t 200.00
Bill Amount : Rupees forty thousand eight hundred seven onty Gross Bill Amount t 40,806.63

Discount

Net Bill Amount 40,807.00

Settlement Details
DocNo
DocDate Narration DocType Amount
tPB2079/448L
26/07/2019 RNEEV UDAIWAL
BI LL
tPR20t9/tL97t 24/07/2019
40,807.OO
ADVANCE
lPR2019/12188 RECEIPT (10,000.00)
26/07/2Ot9 FINALBILLsETTLEMENT
RECEIPT (30,807.00)

Balance Due : { 0.00

Amount Paid by Beneficiary : 40,807.00

Patient Outstanding Amount :
0.00

Prepared By
FOR ETERNAL HEARr CARE Cql,geqAt6
mohinuddin25T5
- ]. i'
L: r'd
/
n

BILL DATE : 26/07/2oL9

PRINT DATE & TIME 14:44:!0

E.& O.E.
Page 4 of 4
 .-l-- __

PATIENT COPY
ETERNAL HEART CARE CENTRE & RESEARCH INSTITUTE
3A, Jagatpura Road, Near Jawahar Circle
Jaipur 3O2O17
CIN No. U851 10RJ2007PTC023653
info@eternalheart.org

GSTIN : 08AACCE0560ALZB

RECE!PT

ReceiptNo: lPR2019/12188
:
Receipt Date & Time 26107/ZOt9 t4:42
visit tD : 546097 :
OPIP No IP-6O7O2 Registration Date & Time : 24/07/2019 10:45

Received with thanks from EHC-OO15G897 MR. RAJEEV UDAIWAL IloB: 79/0717972
A Sum Of Rs. 30807.00/-
Rupees thirty thousand eight hundred seven only
By Credit As FINALBILLSETTLEMENT

Remarks:

Credit Card Details

CardNo: 4638 Card Type : debit

Name of Bank: AXIS

Print Date: 26/0712019

 ETERNAL HEART CARE CENTRE & RESEARCH INSTITUTE
3A, Jagatpura Road, Near Jawahar Circle
Jaipur 302017
m:rmffi.y,q&.x,-
garr CIN No. U851 10RJ2007PTC023653
f,{t r:l*r cc* rx u
r.f rt' *;fi ";;:;Ifi;nrr.i<
T?13qiK..,trKw,,ff 7'r;( info@eternalheart.org

GSTIN : 08AACCE0560ALZB
CASH/CREDIT MEMO

UHID EHC-00156897 Receipt No : oPR2O19/-67943-67944

Patient Name MR. RAJEEV UDAIWAL Receipt Date-Time : 24/07/2019 - t0:72

Patient Age (Yrs) 47 Doctor : DT.LOKESH JAIN

Patient Type Regu la r ReceiptType i CONSOLIDATED

Token No 85

Particulars Quantity Unit Price Amount

Dr. LOKESH JAIN (CONSUL.) < s00.00 < 500.00

RFGISI'RATION < 100.00 { 100.00

Prepared By REKHA253O Total Amount r 600.00

Printed By REKHA253O

Amount Rs. SIX HUNDRED ONLY

Net Amount Payable t 600.00

Amount Received { 600.00

Mode Of Payment : CASH Balance < 0.00

Page 1 of L Print Date/Time 24/07/201"9 10:13:06AM

Signature
 PATIENT COPY

ETERNAL HEART CARE CENTRE & RESEAFICH INSTITUTE

3A, Jagatpura Road, Near Jawahar Circle
JaiPur 3O2O17
CIN No. U851 10RJ2007PTC023653
info@eternalheart.org

GSTIN : 08AACCE056OAIZB

RECEIPT

Receipt Date & Time : 24/07/2Ot9. 76:4O

Receipt No : IPR20L9/II97L
z Registration Date & Time : 24lo7l2ol9 LO:45
Visit lD t 546091 OPIP No lP-60702

DOB: 791071t972
from EHC-00156897 MR, RA'EEV UDAIWAL
Received with thanks

A Sum Of Rs. 10000.00 /-

Rupees ten thousand onlY

By Cash AS ADVANCE

Remarks: - oPD/lPD Advance

Print Date: 24-07-20L9 Print Time: L6:4O:.4t