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  • BILL Create

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    Navodaya Hospital
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    This document contains two medical bills for patient Ms. Urmila Sengar. The first bill from August 30th to September 2nd totals Rs. 47,237 for medicine charges. The accompanying hospital receipt details her treatment from August 30th to September 2nd with a total claimed amount of Rs. 52,269. The second bill from August 13th to August 17th totals Rs. 52,373 for medicine charges. The accompanying hospital receipt details her treatment from August 13th to August 17th with a total claimed amount of Rs. 58,540. Both bills and receipts are for cancer treatment covered by her employee health insurance.

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    This document contains two medical bills for patient Ms. Urmila Sengar. The first bill from August 30th to September 2nd totals Rs. 47,237 for medicine charges. The accompanying hospital receipt details her treatment from August 30th to September 2nd with a total claimed amount of Rs. 52,269. The second bill from August 13th to August 17th totals Rs. 52,373 for medicine charges. The accompanying hospital receipt details her treatment from August 13th to August 17th with a total claimed amount of Rs. 58,540. Both bills and receipts are for cancer treatment covered by her employee health insurance.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    11 views4 pages

    BILL Create

    Uploaded by

    Navodaya Hospital
    This document contains two medical bills for patient Ms. Urmila Sengar. The first bill from August 30th to September 2nd totals Rs. 47,237 for medicine charges. The accompanying hospital receipt details her treatment from August 30th to September 2nd with a total claimed amount of Rs. 52,269. The second bill from August 13th to August 17th totals Rs. 52,373 for medicine charges. The accompanying hospital receipt details her treatment from August 13th to August 17th with a total claimed amount of Rs. 58,540. Both bills and receipts are for cancer treatment covered by her employee health insurance.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 4

    Medicine Bill

    Patient Name: - Ms. Urmila Sengar


    Employee ID: - 1815882521

    S.No. Bill No Bill Date Amount


    1. SCRED-0004228 30.08.2022 16382.00

    2. SCRED-0004262 31.08.2022 10204.00

    3. SCRED-0004287 01.09.2022 10040.00

    4. SCRED-0004305 02.09.2022 10611.00

    Total 47237.00

    Sign & Stamp of Authorized


    Hospital Receipt no-026947
    (D)-Onco

    Name of Patient- Ms. Urmila Sengar


    Treating Doctor- Dr. Shyam Agrawal DOA- 30.08.2022
    Insurance no:- 1815882521 DOD- 02.09.2022
    (A) -Part
    S.No Particular CGHS Code RATE UNIT AMOUNT
    1. DR.FEE (IPD) CGHS 270 3 810.00
    2. GW Stay CGHS-363 1000 3 3000.00
    3. Chemotherapy CGHS-1277 897 1 897.00
    Total(A) 4707.00
    (B) –Part
    Additional Procedure
    1. CBP CGHS-1394 135 2 270.00
    2. Creatinine CGHS-1447 55 1 55.00
    Total(B) 325.00
    (C)-Part
    Medicine Charges 47237.00
    Medicine Details Attached
    Total (C) 47237.00

    TOTAL CLAIMED AMOUNT (A)+(B)+(C) 52269.00


    Certified that the Treatment/Procedure has been done/Performed as per laid down. Norms and Condition
    in the agreement Signed with ESIC.

    Sign & Stamp of Authorized


    Medicine Bill
    Patient Name: - Ms. Urmila Sengar
    Employee ID: - 1815882521

    S.No. Bill No Bill Date Amount


    1. SCRED-0003729 13.08.2022 17522.00

    2. SCRED-0003748 14.08.2022 13166.00

    3. SCRED-0003765 15.08.2022 12478.00

    4. SCRED-0003822 16.08.2022 8420.00


    5. SCRED-0003836 17.08.2022 787.00

    Total 52373.00

    Sign & Stamp of Authorized


    Hospital Receipt no- 026594
    (D)-Onco

    Name of Patient- Ms. Urmila Sengar


    Treating Doctor- Dr. Shyam Agrawal DOA- 13.08.2022
    Insurance no:- 1815882521 DOD- 17.08.2022
    (A) -Part
    S.No Particular CGHS Code RATE UNIT AMOUNT
    1. DR.FEE (IPD) CGHS 270 4 1080.00
    2. GW Stay CGHS-363 1000 4 4000.00
    3. Chemotherapy CGHS-1277 897 1 897.00
    Total(A) 5977.00
    (B) –Part
    Additional Procedure
    1. CBP CGHS-1394 135 1 135.00
    2. Creatinine CGHS-1447 55 1 55.00
    Total(B) 190.00
    (C)-Part
    Medicine Charges 52373.00
    1. Medicine Details Attached
    Total (C) 52373.00

    TOTAL CLAIMED AMOUNT (A)+(B)+(C) 58540.00


    Certified that the Treatment/Procedure has been done/Performed as per laid down. Norms and Condition
    in the agreement Signed with ESIC.

    Sign & Stamp of Authorized

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