INVOICE / RECEIPT

Name : Mr.SUMIT GARG Visit No : PIT210518200

Age/Gender : 38 Y 0 M 4 D /Male Bill : DPITB/21-22/00006538
Contact No : 7531892463 Visit/Reg Date : 26-May-2021 10:11AM
Address : h-no-255/256, 2nd floor, pocket 2 , sec 24 , rohini delhi 11 Refered By : Dr.SELF
UHID : UPIT.0000010865 Center : BTC PITAMPURA
Home Collection : Yes Center Ph. No : 9654886454
Center Address : Shop 3, KP-23, Ground Floor, Pitampura,
Delhi-1100

# Service Code Service Name SIN No. MRP Rate Total

1 43259 D-Dimer CO00032017 1598 799 799

2 43050 Hb A1c ED00177559 540 270 270

3 43117 CBC ED00177559 398 199 199

4 42965 C-Reactive Protein CL00322300 500 250 250

5 43036 TSH CL00322300 340 170 170

Settlement Payment Receipt No Mode Amount Bill Amount : 1688

Settlement 26-05-2021 RPIT/21-22/00006838 Cash 1688 Total Paid Amount : 1688

Received with thanks : One Thousand Six Hundred And Eighty Eight Only Authorized Signature :

For accessing online reports log on to www.houseofdiagnostics.com; Lab ID: PIT210518200; password : 7531892463;
1. Reports are available online for 30 days. Thereafter report are archived for upto 3 years after the test.
2. Images for all modalities film/CD once issued will be re-issued upon an additional charge as per rate list. Images are stored in databank for upto a period of 30 days
only. Thereafter the House Of Diagnostics dose not hold any responsibility / liability of issuance of any such Images on film/CD.
3. Films and Images are normally provided as hard copies. Incase images are needed on a CD, charges will be extra, at applicable rates.
4. Test Group with SIN No. beginning with OS are outsourced and not performed at the House of Diagnostics laboratory.
5. A Whole Body PETCT Scan is done for Head to Mid Thigh region.
6. Call Center: 9089089089; Timing: 7:00 AM to 10:00 PM.
7. No refunds will be made once test is performed.
8. Advance taken for PET CT scan is refundable as per below mentioned point 9, only if cancellation request is made before 8 PM, a day before the test scheduled
date. Any reason for cancellation. Thereafter shall result in forfeiture of Rs. 5000/-.
9. Refund of any test on account of test not done, will take 10 days after completing needful paperwork formalities and will be by NEFT only. Please provide
complete Account details for the NEFT. HOD will not be liable incase wrong bank A/c details are provided. All refunds will be subject to deduction of Rs. 50/- or 2%
of the amount, whichever is higher.
10. Refund or Adjustment of any advance amount paid against any test must be utilized within 90 days of making payment/advance. All such amounts will stand
forfeited after 90 days of making any advance payment.
11. I, hereby give my consent for the above billed tests to be performed on me/my patient.
12. ICMR Registration Number for House Of Diagnostics is HDHPLDD.

Printed By: SHIVANSH TIWARI (CC) Created By: SHAMA CHOPRA (PR) 30-May-2021 05:20 PM Page 1 of 1