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TAX INVOICE

INPATIENT SUMMARY BILL

GST No. : 07AAACE8731F1Z5

CIN No. : U85110CH2000PLC02374

IRN :

IRN QR Code
Pateint Name : Master Mohd Abrahim Mir Bill No : 120122IPCR021459
UHID : 1214662 Bill Date : 07-Dec-2022 1:42 PM

EpisodeNo : 201734/22/1201 Admiited on : 29-Nov-2022 7:35 AM

Age/Sex : 7 MONTH(S)/Male Discharged on : 07-Dec-2022 2:53 PM

Phone No. : 8803108988 Department : CARDIO THORACIC VASCULAR SURGERY

Address : OKEY KULGAM khulgam Treating Doctor : Dr Krishna Subramony Iyer

Claim No. Place of Supply

......................................................................................................................................................................................................................................................................
Customer Details Insurance/Corp : NA

Customer Category : Domestic Other Customer Site : NOTA04264Z-CHANDIGARH

Customer Name : ROTARY CLUB

Customer Address : SECTOR TPA Name:

18A,Kulgam Chowalgam,,
Kulgam Chowalgam 160018,
Kulgam Chowalgam,India
GSTIN : NOTA05660Z
......................................................................................................................................................................................................................................................................
S. No Particulars HSN/SAC Gross Amount Discount Net Final Amount

1 OTHER PROCEDURE 9993111 2000.00 0.00 2000.00

BILL AMOUNT 225625.00 0.00 225625.00

CGST : 812.50

SGST : 812.50

NET BILL AMOUNT : 225625.00

ROTARY CLUB 225625.00

PATIENT SHARE : 0.00

DEPOSIT BY PATIENT ; 0.00

REFUND AMOUNT 0.00

NET PAYABLE AMOUNT : 0.00

INDIVIDUAL CREDIT

Closed By : Anil Kumar Discharge By : Sonia

Patient/Attendant’s Sign :

Name
: : SHOWKAT AHAMAD SOFI
: Relation Phone No : 8803108988
(Note : All original payment receipts required for Final Bill Clearance.

Print Date : 07-Dec-2022 2:54 PM

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