SWASTHYA SUPER SPECIALITY HOSPITAL

AJANTA CO-OPERATIVE SOC., ELLORA PARK CROSSING, NR. TRIDENT COMPLEX, CNG PUMP ROAD, VADODARA - 390023

INTERIM IPD BILL

Bill No : 2011 UHID No : 4772 Bill Date : 26-02-2022

IP No : 2120 Admission Date : 22-02-2022 17:28:26

Patient Name : JASODABEN BHIKHABHAI MAKWANA

Age/Gender : 62 Y / Female Patient Type : CASH Mobile No. : 9998980903

Referral Dr. : DR. DHAVAL PARIKH

Admitting Dr. : DR NIRAV SHAH

Sr. No. Service Name Doctor Name Amount Qty Discount Total Amount

1 IPD Room Charges 4500 5.00 22500.00

2 IPD REGISTRATION 100 1.00 100.00

3 BIO MEDICAL CHARGES 50 5.00 250.00

4 DOCTOR VISIT(MEDICAL OFFICER) 200 9.00 1800.00

5 DOCTOR VISIT ICU DR MEHUL 2000 1.00 2000.00

AGRAVAT

6 DOCTOR VISIT ICU DR NIRAV SHAH 2000 2.00 4000.00

7 DOCTOR VISIT ICU DR BHAVIN 2000 3.00 6000.00

MANDOWARA

8 DOCTOR VISIT ICU DR DHRUV 2000 9.00 18000.00

MADHAVANI

9 DLC CATHERT INSERTION DR BHAVIN 3500 1.00 3500.00

MANDOWARA

10 VEIN FLOW 250 2.00 500.00

11 IV / IM / SC 80 60.00 4800.00

12 IV DRIP 70 70.00 4900.00

13 MULTIPARA MONITORING CHARGES 250 5.00 1250.00

14 BLOOD OR COMPONENT TRANSFUSION 500 1.00 500.00

15 ECG CHARGES 300 1.00 300.00

16 OXYGEN CHARGES (MORE THAN 6 1000 5.00 5000.00

HOURS)

17 RIPPLE BED CHARGES (AIR BED) 250 5.00 1250.00

18 INFUSION PUMP CHARGES 500 5.00 2500.00

19 PATHOLOGY CHARGES 17600 1.00 17600.00

20 RADIOLOGY CHARGES 1200 1.00 1200.00

21 RANDOM BLOOD SUGAR BY 100 25.00 2500.00

GLUCOMETER

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 Total Service Amount: 0 100450.00

Deposit Amount : 0.00

Payable Amount : 100450.00

Discount : 0

Final Payble Amount : 100450.00

Total Bill Paid Amount : 0.00

Pending Bill Amount : : 100,450.00

Current Deposit Amount : 0.00

Remarks : OK

Amount in Words: ZERO Only

DHARA JOSHI admin

26/02/2022 4:05 pm Page 2 of 3

 IPD CASH RECEIPT

Receipt No. : Bill No. : Reg No. :

Receipt Date : Patient Name :

Payment Mode Receipt Amt. :

:
Amt. in Words:

Subject To Vadodara Judicial

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