CIN : U8510KA2003PTC033055

C.S.T :
SERVICE TAX NO : AACCC2943FST001

COLUMBIA ASIA HOSPITAL - WHITEFIELD TIN NO. : 29200650675

DRUG NO. : KA-B61-122719
KA-B61-122723
Survey No.10P & 12P Ramagondanahalli Village
KA-B61-122722
Varthur Hobli Bangalore 560066
KA-B61-122718
KA-B61-122714
Tel : 080-61656666,
KA-B61-122715
Fax : 080-67366699
PAN NO. : AACCC2943F

GSTIN No. : 29AACCC2943F1ZS

IRN :

Insurance Co :

Payor Name : RAJALAKSHMI SESHADRI

PATIENT BILL
Payor Address : B 6 ROW HOUSE, SOBHA ADAMUS, **, Bill No. : CAHW-OPP-1448064
KANNAMANGALA, BANGALORE, 560067
Bill Date/Time : 20/05/2021 03:24:57PM

Cashier Name : SAVITHA.C

Account :
GL No. : Credit Term : 0 Day(s)

Co.Guarantor : Admit Date/Time : 20/05/2021 09:01:34AM

Patient Name : RAJALAKSHMI SESHADRI Discharge Date/Time :

MRN : CAHW-0000117792 V0000000029-CAH Ward/Room/Bed/Type :

W
Priv Code : CASC
Admitting/Primar
y Doctor : Naveen Chandra G Sanjeeva Ganiga ( Cardiology - Charge Type : OutPatient
Interventional )
SI Description Batch / Ord Doc. Qty Amount Disc Taxable CGST* SGST* IGST* Payable Total
SCH MFR UOM
Exp Date Amt Value Amt/Rate Amt/Rate Amt/Rate Amt
HSN/SAC Code

DOCTOR CHARGES
SPECIALIST CONSULTATION
Doctor Name : Naveen Chandra G Sanjeeva Ganiga ( Cardiology - Interventional )

20/05/2021

1 Consultation Naveen Chandra 1.00 900.00 90.00 810.00 810.00

Cardiology OP G Sanjeeva
999312
Ganiga

Sub Total : 900.00 90.00 810.00 810.00

Amount Before Tax Less Discount Total Tax Amount Amount Payable
Deposit Available : 0.00 Amount

Grand Total 900.00 90.00 0.00 810.00

Rounded Off Value 810.00

Tax Breakup **

CGST* : 0.00

SGST* : 0.00
Doc. Amount Allocated Amount
IGST* : 0.00

Total : 0.00

LESS Total Credit Note : 0.00

810.00

Printed By : ANINDITA.B 07/07/2021 13:02:08 Page 1 of 2

 ADD Total Debit note : 0.00

810.00

RPT-2458521 Cash 20/05/2021 09:03:33 810.00

LESS Payment : 810.00

Balance Payable / (Refundable) :

0.00

* CGST, SGST, IGST values includes Cess values where applicable

END OF STATEMENT

This is a computer generated bill and hence no signature required E & O.E
Printed By : ANINDITA.B 07/07/2021 13:02:15 Page 2 of 2