Place Of Supply West Bengal (19) NEOTIA GETWEL HEALTHCARE CENTRE

(A Unit Of Neotia Healthcare Initiative Limited)

Uttorayon, Siliguri, 734010, Darjeeling, Ph : 0353 3053000
CIN No : U85110WB2007PLC113081, GSTIN : 19AACCN4806C1ZQ

BILL OF SUPPLY CUM RECEIPT (FINAL BILL)

Patient Category : Corporate Bill No. : BOS101-2223001850

Patient MRD No. : UID110000321688 Bill Date : May 20, 2022 5:32 PM

Patient Name : Mr SOURABH PARAKH Visit No. : IP-002

Gender / Age : MALE/25 Years Charge Class : Premium

Ward Bed No : FORTH FLOOR (LEVEL 5)/4101N Discharge Type :

Admitted Doctor : Dr. ENT UNIT (DR. A. B. BOSE - DR. K. Admitted Date : May 17, 2022 5:02 PM
D. BHUTIA)
Contact No : 7001304609 Discharge Date : May 19, 2022 11:42 AM

Adrress : 2ND FLOOR, NEAR AMRIT HSN Code : 9993

APARTMENT, DEVI CHOWDHARY
RANI SARANI, EAST MILLANPALLY,
Insurance Company :
PO- SILIGURI, PS- SILIGURI, DIST- Corporate/TPA : BAJAJ ALLIANZ GENERAL
DARJEELING, SILIGURI, SILIGURI, INSURANCE COMPANY(2021-23)
WEST BENGAL, INDIA
Corporate/TPA GSTIN :
Authorization No : 00002600 Authorization Amount : 118577

Description Date MRP Unit Rate Qty Amount

Administrative
ATTENDANT STAY CHARGE - PER DAY. 17-05-2022 500.00 1 500.00

CSSD CHARGE. 17-05-2022 450.00 1 450.00

MRD CHARGES 17-05-2022 500.00 1 500.00

ATTENDANT STAY CHARGE - PER DAY. 18-05-2022 to 19-05-2022 500.00 1 500.00

TPA DOCUMENTATION CHARGES 20-05-2022 500.00 1 500.00

Administrative Total 2,450.00

Sponsor Discount on Administrative 98.00
Bed Charges
PREMIUM SINGLE 17-05-2022 6,200.00 1 6,200.00

PREMIUM SINGLE 18-05-2022 to 19-05-2022 6,200.00 1 6,200.00

Bed Charges Total 12,400.00

Sponsor Discount on Bed Charges 496.00
CONSULTATION
PRE ANAESTHETIST CHECKUP (PAC) | Dr. 19-05-2022 732.00 1 732.00
HIRANMAY ROY

CONSULTATION Total 732.00

Sponsor Discount on CONSULTATION 29.28
Doctors Fee
ANAESTHESIST CHARGES | Dr. HIRANMAY ROY 18-05-2022 9,750.00 1 9,750.00

Doctors Fee Total 9,750.00

Sponsor Discount on Doctors Fee 390.00

Page 1 of 8
 Description Date MRP Unit Rate Qty Amount
IP CONSULTATION
ASSISTANT DOCTOR FEES. 17-05-2022 to 19-05-2022 350.00 2 700.00

IP CONSULTATION GENERAL SPECIALITY | Dr. 19-05-2022 1,050.00 1 1,050.00

ENT UNIT (DR. A. B. BOSE - DR. K. D. BHUTIA)

IP CONSULTATION GENERAL SPECIALITY | Dr. 19-05-2022 1,050.00 2 2,100.00

ENT UNIT (DR. A. B. BOSE - DR. K. D. BHUTIA)

IP CONSULTATION Total 3,850.00

Sponsor Discount on IP CONSULTATION 154.00
Investigation
BIOPSY - SMALL 18-05-2022 1,287.00 1 1,287.00

Investigation Total 1,287.00

Sponsor Discount on Investigation 51.48
Others
FOOD CHARGES (IP) 19-05-2022 53.00 1 53.00

Others Total 53.00

Sponsor Discount on Others 2.12
Procedure
Diet Counseling 17-05-2022 450.00 1 450.00

INFECTION CONTROL SUNDRIES 17-05-2022 450.00 1 450.00

DIATHERMY PENCIL 18-05-2022 120.00 1 120.00

DIATHERMY PLATE 18-05-2022 84.00 1 84.00

INFECTION CONTROL SUNDRIES 18-05-2022 to 19-05-2022 450.00 1 450.00

MICROSHILD PVP - HANDWASH 18-05-2022 80.00 1 80.00

MICROSHILD PVP - S 18-05-2022 72.00 1 72.00

OTHERPROCEDURE SURGICAL DRILL 18-05-2022 3,640.00 1 3,640.00

REUSABLE BUR 31312070 2MM LONG LENGTH- 18-05-2022 1,120.00 1 1,120.00

XOMED

GLUCOMETER (BEDSIDE) 1 TIME 19-05-2022 130.00 1 130.00

REUSABLE BUR 31132070 2MM FINE DIAMOND 18-05-2022 846.00 1 846.00

LONG-XOMED

REUSABLE BUR 31133069 3MM FINE DIAMOND 18-05-2022 898.00 1 898.00

LONG XOMED

Procedure Total 8,340.00

Sponsor Discount on Procedure 333.60

Page 2 of 8
Description Date MRP Unit Rate Qty Amount
Surgery
INSTRUMENT CHARGE (MICROSCOPE) | Dr. ENT 18-05-2022 1,000.00 1 1,000.00
UNIT (DR. A. B. BOSE - DR. K. D. BHUTIA)

OT CHARGES. | Dr. ENT UNIT (DR. A. B. BOSE - DR. 18-05-2022 41,700.00 1 41,700.00
K. D. BHUTIA)

OT KIT CHARGES ( BEYOND 3 HOURS) | Dr. ENT 18-05-2022 3,300.00 1 3,300.00

UNIT (DR. A. B. BOSE - DR. K. D. BHUTIA)

RT MRM | Dr. ANANDABRATA BOSE 18-05-2022 0.00 1 0.00

SURGEON FEE | Dr. ENT UNIT (DR. A. B. BOSE - 18-05-2022 39,000.00 1 39,000.00
DR. K. D. BHUTIA)

Surgery Total 85,000.00

Sponsor Discount on Surgery 3400.00
DRUGGROUP
IV SET - INTRAFIX SAFESET ,SOLID,. (90183990) 17-05-2022 294.00 294.00 1 294.00

N S 100ML AMANTA ,Liquid,100ML (30045020) 17-05-2022 37.92 37.92 1 37.92

N S 100ML AMANTA ,Liquid,100ML (30045020) 17-05-2022 37.92 37.92 3 113.76

N S 500ML AMANTA ,Liquid,500ML (30045020) 17-05-2022 79.31 79.31 1 79.31

SANISCRUB E 100ML - SIRMAXO ,Liquid,.. 17-05-2022 230.00 230.00 1 230.00

CALPOL 650MG TAB 15S ,SOLID,650MG (30049069) 18-05-2022 2.06 2.06 15 30.91

CIS ARTACIL 20MG INJ 10ML (30049099) 18-05-2022 891.00 891.00 1 891.00

KABIMOL FREEFLEX 100ML IV (30049061) 18-05-2022 546.00 546.00 1 546.00

N S 1000ML (30045020) 18-05-2022 52.53 52.53 3 157.59

N S 100ML AMANTA (30045020) 18-05-2022 37.92 37.92 1 37.92

PYROLATE INJ (30049034) 18-05-2022 13.00 13.00 1 13.00

SEPTOJECT NEEDLE 27G/35MM SEPTODENT 18-05-2022 7.00 7.00 1 7.00

VENUS 4400 N95 MASK NIOSH TC-84A-8126 18-05-2022 150.00 150.00 6 900.00
(63079090)

DRUGGROUP Total 3,338.41

Sponsor Discount on DRUGGROUP 133.54
DRUGS
AUGMENTIN 1.2GM INJ ,Liquid,1.2GM (30041090) 17-05-2022 140.97 140.97 1 140.97

Page 3 of 8
Description Date MRP Unit Rate Qty Amount
DRUGS
ADRENALINE INJ 1ML (30043990) 18-05-2022 17.40 17.40 10 174.00

AUGMENTIN DUO 1000MG TAB 10S ,SOLID,. 18-05-2022 54.68 54.68 10 546.80
(30041090)

CIPLOX EYE/EAR DROP 10ML (30042013) 18-05-2022 17.05 17.05 1 17.05

DEXONA INJ (30043913) 18-05-2022 10.45 10.45 1 10.45

EMESET 4ML INJ (30049035) 18-05-2022 26.25 26.25 1 26.25

FENTANYL INJ 2ML ,Liquid,2ML (30049099) 18-05-2022 50.95 50.95 1 50.95

JUSTIN AQ INJ 1ML (30049066) 18-05-2022 19.40 19.40 1 19.40

LEXANOX PLUS ORAL PASTE ,SEMI SOLID,. 18-05-2022 116.10 116.10 1 116.10
(30049099)

LIGNOSPAN SPECIAL INJ 1.8ML (3004) 18-05-2022 70.00 70.00 3 210.00

METOLAR INJ 5ML (30049074) 18-05-2022 19.75 19.75 1 19.75

NEOROF 10ML INJ (30039034) 18-05-2022 79.00 79.00 2 158.00

T BACT OINT 15GM (30019091) 18-05-2022 319.30 319.30 1 319.30

THEMISET 75MG INJ (30049049) 18-05-2022 180.29 180.29 1 180.29

MYO PYROLATE INJ (30049099) 19-05-2022 102.40 102.40 2 204.80

DRUGS Total 2,194.11

Sponsor Discount on DRUGS 87.76
SURGICAL CONSUMABLES
COTTON 50GM ,SOLID,50GM (56012110) 17-05-2022 34.00 34.00 1 34.00

EMERALD SYRINGE 10ML (21G) BLISTER 17-05-2022 30.00 30.00 5 150.00

PACK ,SOLID,10ML (90183100)

EMERALD SYRINGE 2ML BLISTER PACK ,SOLID, 17-05-2022 14.00 14.00 5 70.00
2ML (90183100)

EMERALD SYRINGE 5ML (24G) BLISTER 17-05-2022 22.00 22.00 3 66.00

PACK ,SOLID,5ML (90183100)

EXAMINATION GLOVES (20 X 1PACK) ,SOLID,20S 17-05-2022 200.00 200.00 1 200.00

(40151100)

NEEDLE 18G ,SOLID,. (90183290) 17-05-2022 2.50 2.50 3 7.50

RINGER LACTATE 500ML AMANTA ,Liquid,500ML 17-05-2022 58.59 58.59 1 58.59

(30045020)

Page 4 of 8
 Description Date MRP Unit Rate Qty Amount
SURGICAL CONSUMABLES
ROTA FLO CONTROLLER ,SOLID,. 17-05-2022 489.00 489.00 1 489.00

SURGEONS CAP ,SOLID,. (62103090) 17-05-2022 15.00 15.00 2 30.00

SURGEONS MASK 3PLY ,SOLID,. (62103090) 17-05-2022 10.00 10.00 2 20.00

SYRINGE 1CC DISPOVAN ,SOLID,1ML (90183100) 17-05-2022 8.00 8.00 1 8.00

TEGADERM 1633 ,SOLID,. (30051010) 17-05-2022 162.00 162.00 2 324.00

VENFLON PRO SAFETY 20G ,SOLID,20G (90183930) 17-05-2022 441.00 441.00 2 882.00

WELCOME KIT ,SOLID,. 17-05-2022 75.00 75.00 1 75.00

ABGEL (3006) 18-05-2022 160.00 160.00 1 160.00

CATHETER MOUNTS (90192090) 18-05-2022 442.00 442.00 1 442.00

CLEAN SHEET DISPOSABLE (PLAIN) (90189099) 18-05-2022 41.66 41.66 2 83.32

DISTILLED WATER 10ML (30031000) 18-05-2022 2.60 2.60 2 5.20

DISTILLED WATER 10ML (30031000) 18-05-2022 2.60 2.60 5 13.00

ECG LEAD ADULT 3M (90189099) 18-05-2022 25.30 25.30 3 75.90

EMERALD SYRINGE 10ML (21G) BLISTER PACK 18-05-2022 30.00 30.00 1 30.00
(90183100)

EMERALD SYRINGE 2ML BLISTER PACK 18-05-2022 14.00 14.00 2 28.00

(90183100)

EMERALD SYRINGE 5ML (24G) BLISTER PACK 18-05-2022 22.00 22.00 4 88.00
(90183100)

EMERALD SYRINGE 5ML (24G) BLISTER PACK 18-05-2022 22.00 22.00 2 44.00
(90183100)

ET TUBE NO 7.5 CUFFED (90183990) 18-05-2022 200.00 200.00 1 200.00

EXTENSION 3WAY 100CM - BD (90189099) 18-05-2022 308.50 308.50 1 308.50

EXTENSION 3WAY 100CM - BD (90189099) 18-05-2022 308.50 308.50 1 308.50

GAMJEE PAD (5'' X 10'' ) (30059090) 18-05-2022 120.00 120.00 1 120.00

GAMJEE PAD (5'' X 10'' ) ,SOLID,. (30059090) 18-05-2022 120.00 120.00 3 360.00

Page 5 of 8
Description Date MRP Unit Rate Qty Amount
SURGICAL CONSUMABLES
GAUZE PIECE (7.5X7.5X12PLY - ST) 4PCS PACK 18-05-2022 63.00 63.00 8 504.00
(30059090)

GAUZE PIECE (7.5X7.5X12PLY - ST) 4PCS PACK 18-05-2022 63.00 63.00 2 126.00
(30059090)

GAUZE PIECE (7.5X7.5X12PLY - ST) 4PCS 18-05-2022 63.00 63.00 4 252.00

PACK ,SOLID,. (30059090)

GLOVES NO. 7.0 - SURGICARE ,SOLID,NO 7 18-05-2022 80.00 80.00 1 80.00

(40151100)

GLOVES NO. 7.5 - SURGICARE (40151100) 18-05-2022 80.00 80.00 1 80.00

GLOVES NO. 8.0- SURGICARE (40151100) 18-05-2022 65.00 65.00 1 65.00

HALF GOWN D 800 (90189099) 18-05-2022 61.00 61.00 3 183.00

INCISE DRAPE SMALL D1020 (90189099) 18-05-2022 45.00 45.00 1 45.00

MICROPORE 2 INCH ,SOLID,2 INCH (30051000) 18-05-2022 188.00 188.00 1 188.00

MOPS (30X30X8PLY) 18-05-2022 92.00 92.00 2 184.00

NEEDLE 18G (90183290) 18-05-2022 2.50 2.50 1 2.50

NW 870 PROLENE (90189099) 18-05-2022 434.00 434.00 1 434.00

O SCOPE DRAPE ECO SMALL E214S 18-05-2022 245.00 245.00 1 245.00

PLAIN SHEET D301 (90189099) 18-05-2022 119.00 119.00 1 119.00

POWDER FREE GLOVES NO 6.0 (40151100) 18-05-2022 104.00 104.00 2 208.00

POWDER FREE GLOVES NO 7.0 (40151100) 18-05-2022 104.00 104.00 1 104.00

POWDER FREE GLOVES NO 7.5 (40151100) 18-05-2022 104.00 104.00 1 104.00

RESWAS COUGH SYP 120ML ,SEMI LIQUID,120ML 18-05-2022 108.75 108.75 1 108.75
(30049099)

RINGER LACTATE 500ML AMANTA (30045020) 18-05-2022 58.59 58.59 2 117.18

ROLL BANDAGE 4 INCH (30059040) 18-05-2022 16.00 16.00 3 48.00

ROLL BANDAGE 4 INCH ,SOLID,4 INCH (30059040) 18-05-2022 16.00 16.00 2 32.00

ROLL BANDAGE 6 INCH (30059040) 18-05-2022 20.16 20.16 1 20.16

Page 6 of 8
Description Date MRP Unit Rate Qty Amount
SURGICAL CONSUMABLES
SEVORANE 250 ML 18-05-2022 31.48 31.48 30 944.34

SUCTION CATH NO 14G (90183990) 18-05-2022 73.00 73.00 1 73.00

SURGEONS CAP (62103090) 18-05-2022 15.00 15.00 8 120.00

SURGEONS MASK 3PLY (62103090) 18-05-2022 10.00 10.00 8 80.00

SURGICAL BLADE NO 15 (90189022) 18-05-2022 36.50 36.50 1 36.50

SURGICAL BLADE NO 20 (90189022) 18-05-2022 36.50 36.50 1 36.50

SYRINGE 50CC DISPOVAN (90183100) 18-05-2022 46.00 46.00 2 92.00

VACCU SUCK SUCTION SET (STANDARD TIP) 18-05-2022 487.00 487.00 1 487.00
(90183990)

EMERALD SYRINGE 10ML (21G) BLISTER 17-05-2022 30.00 30.00 -3 -90.00

PACK ,SOLID,10ML (90183100)

EMERALD SYRINGE 2ML BLISTER PACK ,SOLID, 17-05-2022 14.00 14.00 -5 -70.00
2ML (90183100)

EMERALD SYRINGE 5ML (24G) BLISTER PACK 18-05-2022 22.00 22.00 -2 -44.00
(90183100)

NEEDLE 18G ,SOLID,. (90183290) 17-05-2022 2.50 2.50 -3 -7.50

RINGER LACTATE 500ML AMANTA (30045020) 18-05-2022 58.59 58.59 -1 -58.59

ROTA FLO CONTROLLER ,SOLID,. 17-05-2022 489.00 489.00 -1 -489.00

TEGADERM 1633 ,SOLID,. (30051010) 17-05-2022 162.00 162.00 -1 -162.00

VENFLON PRO SAFETY 20G ,SOLID,20G (90183930) 17-05-2022 441.00 441.00 -1 -441.00

SURGICAL CONSUMABLES Total 8,437.36

Sponsor Discount on SURGICAL CONSUMABLES 337.50
Total Hospital Charges 137,831.88
Round Off +0.4043
Final Bill Amount 137,832.28
Amount in words : Rupees One Lakh Thirty Seven Thousand Eight Hundred Thirty Two and Twenty Eight Paisa Only

Sl No. Receipt Date Receipt No Payment Type Adjusted Amt.

1 May 17, 2022 5:10 PM REC-101-2223030131 On Account 5,000.00
Total 5,000.00
Sl No Receipt Date Receipt No Payment Type Amount

1 May 20, 2022 5:32 PM REC-101-2223032307 Invoice Collection 8,742.00

Total 8,742.00

Net Amount 132,319.00

Page 7 of 8
 :
Patient Payable : 13742.00
Less advance : 13,742.00
Sponsor Amount : 118577.00
Sponsor Discount Amount : 5513.28
Patient Payable Balance : 0.00
Outstanding Amount : 118,577.00

Authorised Signatory
Prepared By NEKHAT.A Prepared On May 20, 2022 5:32 PM

Page 8 of 8