Name of Hospital

Hospital Address
Hospital Contact Number

INVOICE
Date :

Number :

Patient Name : Age :

Address : Hospital No. :
Bed No. :
Admission Date :
Discharge Date :
Consultant :
Mode of Payment :

SR # PARTICULARS UNIT PRICE AMOUNT

Sub-total :
-
If you have questions regarding this invoice, please Tax Rate :
contact <Name of point person>, <contact number>, and -
<email address>. Tax :
-
Mediclaim (if any) :
-
Prepared by: Payment/s made :
-
Total Bill :
-
<Insert Name>/<Designation>