FINAL BILL

Patient Name: MRS. KANUBEN MOLIYA Bill No/Reg No – 052601/2022

Age: 53 YEARS Gender: FEMALE CLAIM NO – 220011112P
Date of Admission: 25-05-2022 Time – 08:00 AM REF. ID NO - 20220526000193
Date of Discharge: 26-05-2022 Time – 12:15 PM
Bill in Favour of – BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
TPA – BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
Treating Dr – Dr. SONAL K SHAH (MD, GYNAEC)

Sr. No. Particulars Net Amt.

TOTAL LAP. HYSTERECTOMY SURGERY CHARGES

– Deluxe A/C Room 75,000=00
1
(Applicable Room Rent = 1500/Day – As per MOU)
(Room as Selected by Patient)

NET AMOUNT PAYABLE BY INS/TPA CO. 75,000=00

Total in Words – Seventy Five Thousand Rupees Only /-