Plot No.

-1, Sector-47,Gurugram-122018, Haryana

gurugram,haryana
india,
0124423805

UHID 55378 IP Number IP20/52

Patient Name Mrs Rasmeena Admission Date Time 17-11-2020 03:02:19 PM
Age / Gender 54 Y/Female Discharge Date Time 17-11-2020 06:53:28 PM
Patient Address 2GurugramHaryana Bill No. IPB45
Bill Date Time 17-11-2020 06:54:08 PM Admitting Doctor Dr Asif Mir
Bed No. / Billing Category 206B / SINGLE ROOM Treating Doctor Dr Asif Mir
Payer Type cash Payer Name Self

IP Final Bill Detail (Amount in Rs)

S.N Servic Date Service Name Billing Price Qty Amoun Disc Net Service Priority
e Type Catego t Amoun Code
ry t
1 Procedu 17-11- IV Cannulization SINGLE 200.00 1.00 200.00 7.09 192.91 ER5080
re 2020 ROOM
2 Procedu 17-11- Iv Infusion SINGLE 300.00 1.00 300.00 10.64 289.36 ER5033
re 2020 ROOM
3 Administ 17-11- Dietician Charge SINGLE 500.00 1.00 500.00 17.73 482.27
ration 2020 ROOM
4 IP 17-11- Dr Asif Mir SINGLE 1,000.008.00 8,000.00283.60 7,716.40 Routine
Consult 2020 ROOM
ation
5 Administ 17-11- Bed Charges SINGLE 4,500.002.00 9,000.00319.05 8,680.95
ration 2020 ROOM
6 Administ 17-11- Bed Charges SINGLE 2,250.001.00 2,250.0079.76 2,170.24
ration 2020 ROOM
7 Radiolo 17-11- X-Ray Abdomen - Supine SINGLE 550.00 1.00 550.00 19.50 530.50
gy 2020 ROOM
8 Procedu 17-11- Lap. Cholecystectomy SINGLE 20,200.01.00 20,200.0693.66 19,506.3
re 2020 ROOM 0 0 4
9 Procedu 17-11- Lap. Cholecystectomy SINGLE 6,060.001.00 6,060.00214.83 5,845.17
re 2020 ROOM
10 Procedu 17-11- Ryles Tube Insertion SINGLE 1,120.001.00 1,120.0039.70 1,080.30
re 2020 (Adult) ROOM
11 Patholo 17-11- Histo Biopsy Medium SINGLE 1,630.001.00 1,630.0057.78 1,572.22
gy 2020 Specimens ROOM
12 Cardiolo 17-11- ECG Bedside SINGLE 420.00 1.00 420.00 14.89 405.11
gy 2020 ROOM
13 Radiolo 17-11- X-Ray Chest -Pa SINGLE 490.00 1.00 490.00 17.37 472.63
gy 2020 ROOM
14 Radiolo 17-11- X-Ray Abdomen - Erect SINGLE 490.00 1.00 490.00 17.37 472.63
gy 2020 ROOM
15 Pharma 17-11- VENFLON IV CANNULA SINGLE 195.00 1.00 195.00 6.95 188.05 9018
cy and 2020 20G ROOM
Consum
able(Iss
ued
Items)
16 Pharma 17-11- VOVERAN INJ 1*1ML SINGLE 24.55 3.00 73.65 2.63 71.02 1
cy and 2020 ROOM
Consum
able(Iss
ued
Items)
17 Pharma 17-11- SYRINGE-3 ML SINGLE 6.00 2.00 12.00 .43 11.57 3004
cy and 2020 DISPOVAN 1*1 ROOM
Consum
able(Iss
ued
Items)
18 Pharma 17-11- PANTOP INJ 1*1 SINGLE 49.70 2.00 99.40 3.55 95.85 3004
cy and 2020 ROOM
1 of 7
 Plot No.-1, Sector-47,Gurugram-122018, Haryana
gurugram,haryana
india,
0124423805

UHID 55378 IP Number IP20/52

Patient Name Mrs Rasmeena Admission Date Time 17-11-2020 03:02:19 PM
Age / Gender 54 Y/Female Discharge Date Time 17-11-2020 06:53:28 PM
Patient Address 2GurugramHaryana Bill No. IPB45
Bill Date Time 17-11-2020 06:54:08 PM Admitting Doctor Dr Asif Mir
Bed No. / Billing Category 206B / SINGLE ROOM Treating Doctor Dr Asif Mir
Payer Type cash Payer Name Self

IP Final Bill Detail (Amount in Rs)

S.N Servic Date Service Name Billing Price Qty Amoun Disc Net Service Priority
e Type Catego t Amoun Code
ry t
Consum
able(Iss
ued
Items)
19 Pharma 17-11- MIKACIN-500MG INJ SINGLE 92.00 3.00 276.00 9.84 266.16 3004
cy and 2020 1*1VIAL ROOM
Consum
able(Iss
ued
Items)
20 Pharma 17-11- MONOCEF-1GM INJ SINGLE 60.20 2.00 120.40 4.29 116.11 3004
cy and 2020 1*1VIAL ROOM
Consum
able(Iss
ued
Items)
21 Pharma 17-11- BLADE 15 NO SINGLE 5.00 1.00 5.00 .18 4.82 9018
cy and 2020 (GLASSVAN) 1*1 ROOM
Consum
able(Iss
ued
Items)
22 Pharma 17-11- ECG-1800 SINGLE 23.10 2.00 46.20 1.65 44.55 9018
cy and 2020 ELECTROD(1000/BCG) ROOM
Consum 1*1
able(Iss
ued
Items)
23 Pharma 17-11- MONOCRYL 3-0 NW1326 SINGLE 708.00 1.00 708.00 25.25 682.75 3006
cy and 2020 1*1 ROOM
Consum
able(Iss
ued
Items)
24 Pharma 17-11- EMESET-4MG INJ 1*2ML SINGLE 12.81 2.00 25.62 .91 24.71 3004
cy and 2020 ROOM
Consum
able(Iss
ued
Items)
25 Pharma 17-11- PORT CLOSER SUTURE SINGLE 591.00 1.00 591.00 21.08 569.92 3006
cy and 2020 LNW-9323 ROOM
Consum
able(Iss
ued
Items)
26 Pharma 17-11- PYROLATE INJ 1ML SINGLE 12.80 4.00 51.20 1.83 49.37 3004
cy and 2020 1*1ML ROOM
Consu
2 of 7
 Plot No.-1, Sector-47,Gurugram-122018, Haryana
gurugram,haryana
india,
0124423805

UHID 55378 IP Number IP20/52

Patient Name Mrs Rasmeena Admission Date Time 17-11-2020 03:02:19 PM
Age / Gender 54 Y/Female Discharge Date Time 17-11-2020 06:53:28 PM
Patient Address 2GurugramHaryana Bill No. IPB45
Bill Date Time 17-11-2020 06:54:08 PM Admitting Doctor Dr Asif Mir
Bed No. / Billing Category 206B / SINGLE ROOM Treating Doctor Dr Asif Mir
Payer Type cash Payer Name Self

IP Final Bill Detail (Amount in Rs)

S.N Servic Date Service Name Billing Price Qty Amoun Disc Net Service Priority
e Type Catego t Amoun Code
ry t
mable(Is
sued
Items)
27 Pharma 17-11- ISO PROPYL ALCOHOL SINGLE 100.00 1.00 100.00 3.57 96.43 1
cy and 2020 ARORA 100 1*100ML ROOM
Consum
able(Iss
ued
Items)
28 Pharma 17-11- SOFT SWAB GAUZE SINGLE 70.00 6.00 420.00 14.98 405.02 3005
cy and 2020 (10*10) ROOM
Consum
able(Iss
ued
Items)
29 Pharma 17-11- ROMO LENE NO-16 1*16 SINGLE 61.00 1.00 61.00 2.18 58.82 9018
cy and 2020 NO ROOM
Consum
able(Iss
ued
Items)
30 Pharma 17-11- E.T. TUBE CUFFED 7.5 SINGLE 200.00 1.00 200.00 7.13 192.87 9019
cy and 2020 1*1 ROOM
Consum
able(Iss
ued
Items)
31 Pharma 17-11- HANDSHIELD P.V.10% SINGLE 87.00 2.00 174.00 6.21 167.79 1
cy and 2020 1*100ML ROOM
Consum
able(Iss
ued
Items)
32 Pharma 17-11- GLOVES 7.5 NO SINGLE 65.00 4.00 260.00 9.27 250.73 3006
cy and 2020 (SURGICARE) ROOM
Consum
able(Iss
ued
Items)
33 Pharma 17-11- SYRINGE 10 ML 1*10ML SINGLE 23.00 5.00 115.00 4.10 110.90 1
cy and 2020 ROOM
Consum
able(Iss
ued
Items)
34 Pharma 17-11- FACE MASKELASTIC 1*1 SINGLE 10.00 2.00 20.00 .71 19.29 3304
cy and 2020 ROOM
Consum
able
3 of 7
 Plot No.-1, Sector-47,Gurugram-122018, Haryana
gurugram,haryana
india,
0124423805

UHID 55378 IP Number IP20/52

Patient Name Mrs Rasmeena Admission Date Time 17-11-2020 03:02:19 PM
Age / Gender 54 Y/Female Discharge Date Time 17-11-2020 06:53:28 PM
Patient Address 2GurugramHaryana Bill No. IPB45
Bill Date Time 17-11-2020 06:54:08 PM Admitting Doctor Dr Asif Mir
Bed No. / Billing Category 206B / SINGLE ROOM Treating Doctor Dr Asif Mir
Payer Type cash Payer Name Self

IP Final Bill Detail (Amount in Rs)

S.N Servic Date Service Name Billing Price Qty Amoun Disc Net Service Priority
e Type Catego t Amoun Code
ry t
(Issued
Items)
35 Pharma 17-11- EXTEENA DUO 1*30 SINGLE 360.00 1.00 360.00 12.84 347.16 1
cy and 2020 ROOM
Consum
able(Iss
ued
Items)
36 Pharma 17-11- GLOVES 7.0NO SINGLE 78.00 2.00 156.00 5.56 150.44 3004
cy and 2020 (SURGICARE) ROOM
Consum
able(Iss
ued
Items)
37 Pharma 17-11- GLOVES-6.5 NO SINGLE 65.00 2.00 130.00 4.64 125.36 3006
cy and 2020 (SURGICARE) 1*2PC ROOM
Consum
able(Iss
ued
Items)
38 Pharma 17-11- IV SET (ROMSONS) SINGLE 163.00 1.00 163.00 5.81 157.19 3004
cy and 2020 1*1PCS ROOM
Consum
able(Iss
ued
Items)
39 Pharma 17-11- VACCU SUCK SET SINGLE 372.00 1.00 372.00 13.27 358.73 1
cy and 2020 STANDARD TIP 1*1 ROOM
Consum
able(Iss
ued
Items)
40 Pharma 17-11- CAP DISPOSABLE 1*1 SINGLE 10.00 6.00 60.00 2.14 57.86 3004
cy and 2020 ROOM
Consum
able(Iss
ued
Items)
41 Pharma 17-11- URO BAG 1*1PCS SINGLE 220.00 1.00 220.00 7.85 212.15 9018
cy and 2020 ROOM
Consum
able(Iss
ued
Items)
42 Pharma 17-11- SYRINGE-5 ML SINGLE 6.50 6.00 39.00 .93 38.07 1
cy and 2020 DISPOVAN 1*5ML ROOM
Consum
able(Iss
ued
4 of 7
 Plot No.-1, Sector-47,Gurugram-122018, Haryana
gurugram,haryana
india,
0124423805

UHID 55378 IP Number IP20/52

Patient Name Mrs Rasmeena Admission Date Time 17-11-2020 03:02:19 PM
Age / Gender 54 Y/Female Discharge Date Time 17-11-2020 06:53:28 PM
Patient Address 2GurugramHaryana Bill No. IPB45
Bill Date Time 17-11-2020 06:54:08 PM Admitting Doctor Dr Asif Mir
Bed No. / Billing Category 206B / SINGLE ROOM Treating Doctor Dr Asif Mir
Payer Type cash Payer Name Self

IP Final Bill Detail (Amount in Rs)

S.N Servic Date Service Name Billing Price Qty Amoun Disc Net Service Priority
e Type Catego t Amoun Code
ry t
Items)
43 Pharma 17-11- SOFT SWAB GAUZE SINGLE 60.00 6.00 360.00 .00 360.00 3005
cy and 2020 (10*10) ROOM
Consum
able(Iss
ued
Items)
44 Pharma 17-11- SYRINGE-3 ML SINGLE 6.50 3.00 19.50 .00 19.50 3004
cy and 2020 DISPOVAN 1*1 ROOM
Consum
able(Iss
ued
Items)
45 Pharma 17-11- EMESET-4MG INJ 1*2ML SINGLE 12.81 2.00 25.62 .91 24.71 3004
cy and 2020 ROOM
Consum
able(Iss
ued
Items)
46 Pharma 17-11- MONOCEF-1GM INJ SINGLE 60.20 3.00 180.60 6.44 174.16 3004
cy and 2020 1*1VIAL ROOM
Consum
able(Iss
ued
Items)
47 Pharma 17-11- ROMO LENE NO-14 1*14 SINGLE 57.00 1.00 57.00 2.03 54.97 9018
cy and 2020 NO ROOM
Consum
able(Iss
ued
Items)
48 Pharma 17-11- IV SET (ROMSONS) SINGLE 163.00 1.00 163.00 5.81 157.19 3004
cy and 2020 1*1PCS ROOM
Consum
able(Iss
ued
Items)
49 Pharma 17-11- SYRINGE 5ML 1*5 ML SINGLE 17.00 32.00 544.00 .00 544.00 9018
cy and 2020 ROOM
Consum
able(Iss
ued
Items)
50 Pharma 17-11- PANTOP INJ 1*1 SINGLE 49.70 2.00 99.40 3.55 95.85 3004
cy and 2020 ROOM
Consum
able(Iss
ued

5 of 7
 Plot No.-1, Sector-47,Gurugram-122018, Haryana
gurugram,haryana
india,
0124423805

UHID 55378 IP Number IP20/52

Patient Name Mrs Rasmeena Admission Date Time 17-11-2020 03:02:19 PM
Age / Gender 54 Y/Female Discharge Date Time 17-11-2020 06:53:28 PM
Patient Address 2GurugramHaryana Bill No. IPB45
Bill Date Time 17-11-2020 06:54:08 PM Admitting Doctor Dr Asif Mir
Bed No. / Billing Category 206B / SINGLE ROOM Treating Doctor Dr Asif Mir
Payer Type cash Payer Name Self

IP Final Bill Detail (Amount in Rs)

S.N Servic Date Service Name Billing Price Qty Amoun Disc Net Service Priority
e Type Catego t Amoun Code
ry t
Items)
51 Pharma 17-11- VENFLON IV CANNULA SINGLE 214.00 1.00 214.00 7.63 206.37 9018
cy and 2020 20G ROOM
Consum
able(Iss
ued
Items)
52 Pharma 17-11- VOVERAN INJ 1*1ML SINGLE 24.55 1.00 24.55 .88 23.67 1
cy and 2020 ROOM
Consum
able(Iss
ued
Items)
53 Pharma 17-11- SYRINGE-5 ML SINGLE 6.50 2.00 -13.00 .00 -13.00 1
cy and 2020 DISPOVAN 1*5ML ROOM
Consum
able(Ret
urned
Items)

54 Pharma 17-11- SYRINGE 5ML 1*5 ML SINGLE 17.00 32.00 -544.00 .00 -544.00 9018
cy and 2020 ROOM
Consum
able(Ret
urned
Items)

55 Pharma 17-11- SYRINGE-3 ML SINGLE 6.50 3.00 -19.50 .00 -19.50 3004
cy and 2020 DISPOVAN 1*1 ROOM
Consum
able(Ret
urned
Items)

56 Pharma 17-11- SOFT SWAB GAUZE SINGLE 60.00 6.00 -360.00 .00 -360.00 3005
cy and 2020 (10*10) ROOM
Consum
able(Ret
urned
Items)

6 of 7
 Plot No.-1, Sector-47,Gurugram-122018, Haryana
gurugram,haryana
india,
0124423805

UHID 55378 IP Number IP20/52

Patient Name Mrs Rasmeena Admission Date Time 17-11-2020 03:02:19 PM
Age / Gender 54 Y/Female Discharge Date Time 17-11-2020 06:53:28 PM
Patient Address 2GurugramHaryana Bill No. IPB45
Bill Date Time 17-11-2020 06:54:08 PM Admitting Doctor Dr Asif Mir
Bed No. / Billing Category 206B / SINGLE ROOM Treating Doctor Dr Asif Mir
Payer Type cash Payer Name Self

Payment Details:
S.N Date & Time Mode Receipt No Transaction Type Amount
1 17-11-2020 06:54:08 cash IPB45 PAID SETTLEMENT 50,000.00
PM
2 17-11-2020 06:55:29 paytm IPR87 DUE SETTLEMENT 5,015.00
PM

Total Amount 57014.64

Discount 2000.0
Net Amount 55014.64
Round Off 0.36
Paid Amount 55015.0

Patient Attendant signature Printed By Created By

Rasmeena Anandita Verma

(*********** Electronically Generated Report ***********)

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