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PATIENT’S DETAILS
NAME: VENUE:
SHIRIN WISSANJI SUNNI MUSLIM POLYCLINIC
AGE/SEX: AD/FEMALE DATE/TIME: 13TH MARCH 2023

THE DETAILS OF SERVICE PROVIDED ARE AS FOLLOWS:

S.NO SERVICES PROVIDED AMOUNT
(TSH)
01. EMERGENCY SERVICES DAY: NIL
NIGHT:
02. CONSULTATIONS 30,000/=
03. TRANSPORT DAY: 10,000/=
NIGHT:
04. REGISTRATION/DOCUMENTATION NIL
05. ROOM CHARGES NIL
06. INJECTIONS & MEDICINE 39,500/=
07. NURSING 10,000/=
08. LABORATORY TESTS NIL
10. OTHERS (PROCEDURE) NIL
TOTAL 89,500/=

TOTAL IN WORDS: CASH RECEIVED BY:

Tsh. EIGHTY-NINE THOUSAND AND FIVE
HUNDRED ONLY.
GET WELL WISHES

BY ADMINISTRATOR
SMCD/RPC POLYCLINICS