In-patient bill (Details)

I.P. No. : IP23/7004 Original Bill No. : PROVISIONAL

UHID : 215270 Run Date : 04/07/2023 02:53 PM
Patient Name : Mr. HEMANTH KUMAR : Dr. Abhishek Vijay Kumar
Consultant
Gender/Age : Male/24 Yr 1 Mth 8 Days
Adm. Category : TWIN SHARING
Contact No : 6363980814 : 04/07/2023 09:00
D.O.A
Address : NERALA GATTA KASUBU HOBLI DODBALLAPURABANGALORE :
D.O.D
Payer : Pristyn Care Bed No/Ward : 115/FIRST FLOOR
Sponsor : Pristyn Care Dis. Category : TWIN SHARING

Date Particulars Rate Qty Amount

BED CHARGES
04/07/2023 - 04/07/2023 TWIN SHARING 3500.00 1.00 3500.00
Total for BED CHARGES 3500.00
LABORATORY
04/07/2023 09:00 - IP24/61017 RANDOM BLOOD SUGAR 90.00 1.00 90.00
04/07/2023 09:00 - IP24/61017 BLOOD UREA 155.00 1.00 155.00
04/07/2023 09:00 - IP24/61017 CREATININE 130.00 1.00 130.00
04/07/2023 09:00 - IP24/61017 ELECTROLYTES (K, CL, NA) 570.00 1.00 570.00
04/07/2023 09:00 - IP24/61017 COMPLETE BLOOD COUNT (CBC) 285.00 1.00 285.00
04/07/2023 09:00 - IP24/61017 HIV (I & II) RAPID 1040.00 1.00 1040.00
04/07/2023 09:00 - IP24/61017 HBSAG (RAPID CARD TEST) 820.00 1.00 820.00
04/07/2023 09:00 - IP24/61017 HCV RAPID 1145.00 1.00 1145.00
Total for LABORATORY 4235.00
MISCELLANEOUS CHARGES
04/07/2023 09:00 - IP24/60893 MRD CHARGES 750.00 1.00 750.00
Total for MISCELLANEOUS CHARGES 750.00
Medicines Items
04/07/2023 11:07:00 - PH129/23- C TAX 1GM INJECTION [B.No:-Z01BN23006] [ExpDate:- 44.75 1.00 44.75
24/12658 30/09/2025]
04/07/2023 11:07:00 - PH129/23- BETT 0.5ML INJECTION [B.No:-A0152722] [ExpDate:-30/10/2025] 12.64 1.00 12.64
24/12658
04/07/2023 11:07:00 - PH129/23- LOX 2%30ML INJECTION [B.No:-KM144121] [ExpDate:-30/01/2025] 31.24 1.00 31.24
24/12658
Total for Medicines Items 88.63
Surgical Items
04/07/2023 11:29:00 - PH129/23- OCTENISAN WASH LOTION 150ML MAKE-SCHULKE [B.No:- 330.00 1.00 330.00
24/12660 1591050] [ExpDate:-31/03/2025]
04/07/2023 11:40:00 - II129/23-22006 SYRINGE-10ML-21G-NIPRO [B.No:-23A16K56] [ExpDate:- 23.00 3.00 69.00
30/12/2027]
04/07/2023 11:40:00 - II129/23-22006 SYRINGE-2.5ML-24G-NIPRO [B.No:-23B15K39] [ExpDate:- 9.50 2.00 19.00
30/01/2028]
04/07/2023 11:40:00 - II129/23-22006 SYRINGE-5ML-24G-NIPRO [B.No:-22L20K38] [ExpDate:- 18.00 3.00 54.00
30/11/2027]
04/07/2023 11:40:00 - II129/23-22006 DISPOSABLE FACE MASK -3PLY/BLUE COLOUR LOOP [B.No:- 10.00 2.00 20.00
SBRI4104] [ExpDate:-02/04/2025]
04/07/2023 13:54:00 - I 129/23-24/75 PATIENT ID BAND ADULT -BLUE [B.No:-14.10.2022] [ExpDate:- 9.50 1.00 9.50
02/10/2026]
04/07/2023 13:54:00 - I 129/23-24/75 VENFLON PRO SAFETY CANNULA SIZE-18G [B.No:-2356132] 485.00 1.00 485.00
[ExpDate:-30/12/2025]

Printed By: VHRT275 Prepared By: Page No : 1 of 2 Print Date & Time: 04/07/2023 02:53 PM
 I.P. No. : IP23/7004 Patient Name : Mr. HEMANTH KUMAR Bill No. : PROVISIONAL

04/07/2023 13:54:00 - I 129/23-24/75 TEGADERM IV 100/BX,4 BX/C 1683 [B.No:-33MLLC] [ExpDate:- 218.00 1.00 218.00
30/11/2024]
04/07/2023 13:54:00 - I 129/23-24/75 GLOVES - XAMCARE MEDIUM - EXAMINATION-LATEX-NON ST 12.00 10.00 120.00
[B.No:-E4156] [ExpDate:-30/07/2027]
04/07/2023 13:54:00 - I 129/23-24/75 Q-SYTE STANDALONE CLOSED PORT STAND ALONE MAKE -BD 165.50 1.00 165.50
[B.No:-1348372] [ExpDate:-30/10/2026]
04/07/2023 13:54:00 - I 129/23-24/75 SYRINGE-10ML-21G-NIPRO [B.No:-22L01K86] [ExpDate:- 23.00 3.00 69.00
30/11/2027]
04/07/2023 13:54:00 - I 129/23-24/75 SYRINGE-5ML-24G-NIPRO [B.No:-22L05K75] [ExpDate:- 16.50 3.00 49.50
30/08/2027]
04/07/2023 13:54:00 - I 129/23-24/75 ALCO SWAB ISOPROPYL - REF - SS-6090 - 100 PACK [B.No:- 2.50 2.00 5.00
G220121008] [ExpDate:-31/12/2026]
Total for Surgical Items 1613.50
Surgical Items(Return)
04/07/2023 14:14:00 - PH203/23- OCTENISAN WASH LOTION 150ML MAKE-SCHULKE [B.No:- 330.00 1.00 -330.00
24/1646 1591050] [ExpDate:-31/03/2025]
Total for Surgical Items(Return) -330.00
Medicines Items(Return)
04/07/2023 14:14:00 - PH203/23- LOX 2%30ML INJECTION [B.No:-KM144121] [ExpDate:-30/01/2025] 31.24 1.00 -31.24
24/1646
Total for Medicines Items(Return) -31.24
ROUND OFF
04/07/2023 14:53 - IP24/61237 Round Off .11 1.00 0.11
Total for ROUND OFF 0.11
Total Amount 9826.00

Net Amount 9826.00

Net Amount (Incl. Tax) 9826.00

Amount To Be Received (Rs.) 9826.00

Patient's /Attendant's Signature Authorised Signatory

Printed By: VHRT275 Prepared By: Page No : 2 of 2 Print Date & Time: 04/07/2023 02:53 PM