Corporate Office: 250-D, Udyog Bhavan, Hind Cycle Marg, Behind Glaxo, Worli, Mumbai - 400 030

National Reference Lab: 4th Floor, Commercial Building-1A, Kohinoor Mall, Vidyavihar West, Mumbai –
400070

Bill cum receipt

MR. PURUSHOTTAM
Name : SHRIKISANJI Bill Date : 18/07/2022 09:22 AM
CHANDAK
Patient No : P522200026851 Bill No : 122381757
Visit No : 220052000029366 Contact No : 9096625850
Age/Gender : 43 Year(s) / M Email : purushottam_chandak@yahoo.co.in
Mode of
Ref Doctor : DR. DR SELF : Email, Sms
Delivery
APSC-ROSHAN
Client :
BHASKAR KADAM
Tests Report Date Amount
SARS- CoV-2 (COVID 19) Detection by Real Time PCR 19/07/2022 08:04 PM 500.00
Gross Total : 500.00
Tax : 0.00
Discount : 0.00
Amount Date & Time
INR - 500.00 18/07/2022 09:22 AM
Grand Total : 500.00 INR
Received Amount : 500.00 INR
Due Amount : 0.00 INR
Amount Received in
: (INR) FIVE HUNDRED
Words
BILLE RA2108
Health service by clinical :
Category of Service : D BY 109
establishment.
Bill Location : APSC-ROSHAN BHASKAR KADAM

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