SUM HOSPITAL

K-8,Kalinga Nagar, BBSR, Odisha

Bhubaneswar,,Odisha
In-Patient Account Statement

Patient Name : SRINIKA JENA UHID No : SUM.202302031402

Age/Sex : 7 yrs/ F Episode No : 14

Mobile No : 7978393609 Sponsor : SOA STAFF

Ward Name : WARD-16 (PAEDIATRICS) Bed No : W16-11

Address : Khurda KHORDHA Patient Type : GENERAL

Sr No Invoice Date Invoice No Service Name Quantity UOM Rate Amount Status

Bed And Cabin Charges

1 30-Aug-2023 05:14:PM INV/BED/107202308300009340 WARD-16 (PAEDIATRICS) 1 NOS 0 0.00 Paid
2 31-Aug-2023 03:00:AM INV/BED/107202308310003603 WARD-16 (PAEDIATRICS) 1 NOS 0 0.00 Paid

Total Of Bed And Cabin Charges Paid 0.00

Deposit Service
3 30-Aug-2023 05:15:PM RECP/A/109202308300009424 1 NOS 5000 5000.00

Total Of Deposit Service 5000.00

Drug Sale
4 30-Aug-2023 06:56:PM IPDPH/2023-24/348952 CEFAXONE 1GM INJ 3 UNIT 46.40 139.20 Paid
5 30-Aug-2023 06:56:PM IPDPH/2023-24/348952 DNS 500ML INFUSION (NIRLIFE) 2 BOTTLE 42.80 85.60 Paid
6 30-Aug-2023 06:56:PM IPDPH/2023-24/348952 STERI FLO IV SET 1 UNIT 241 241.00 Paid
7 30-Aug-2023 06:56:PM IPDPH/2023-24/348952 DISPOVAN 5ML WITH NEEDLE 8 UNIT 8.50 68.00 Paid
8 30-Aug-2023 06:56:PM IPDPH/2023-24/348952 CATHY 22G IV CANNULA WITH PORT 1 UNIT 213.50 213.50 Paid
9 30-Aug-2023 06:56:PM IPDPH/2023-24/348952 DISPOVAN 2ML WITH NEEDLE 2 UNIT 4.95 9.90 Paid
10 30-Aug-2023 06:56:PM IPDPH/2023-24/348952 PANTAKIND INJ 1 STRIP 56.50 56.50 Paid
11 30-Aug-2023 06:56:PM IPDPH/2023-24/348952 NEOMOL 150MG INJ 4 UNIT 8 32.00 Paid

Total Of Drug Sale Paid 845.70

Laboratory Investigation
12 30-Aug-2023 05:17:PM INV/107202308300009360 CRP(QUANTITATIVE) (SL NO-1459) 1 NOS 310 310.00 Paid
13 30-Aug-2023 05:17:PM INV/107202308300009362 CULTURE AND SENSITIVITY - BLOOD 1 NOS 900 900.00 Paid
(SL NO. 1739)
14 30-Aug-2023 05:17:PM INV/107202308300009368 CULTURE AND SENSITIVITY ( SL NO. 1 NOS 525 525.00 Paid
1739)

Total Of Laboratory Investigation Paid 1735.00

REF
15 31-Aug-2023 12:21:PM 1402023083100000006 Payment Refund 1 NOS 2419.30 2419.30 REF

Total Of REF REF 2419.30

 SUM HOSPITAL
K-8,Kalinga Nagar, BBSR, Odisha
Bhubaneswar,,Odisha
In-Patient Account Statement

Patient Name : SRINIKA JENA UHID No : SUM.202302031402

Age/Sex : 7 yrs/ F Episode No : 14

Mobile No : 7978393609 Sponsor : SOA STAFF

Ward Name : WARD-16 (PAEDIATRICS) Bed No : W16-11

Address : Khurda KHORDHA Patient Type : GENERAL

Sr No Invoice Date Invoice No Service Name Quantity UOM Rate Amount Status

Total Cash Billing (UnPaid) Total Deposit Amount 5000.00

Bed Service Drug Sale Service Booked Total Cash Payment Amount(+) 0.00

Total Credit Amount(+) 0.00

0 0 0
Total Sponsor Approved Amount(+) 0.00

Final Settelment Amount(+) 0.00

Total Cash Billing (Paid)
Total Refund Amount(-) 2419.30
Bed Service Drug Sale Service Booked Total Paid Amount (A) 2580.70

0 0 0 Total Service Billed Amount 2580.70

Total Drug Return Amount(-) 0.00

Total Service Cancel Amount(-) 0.00

Bed Refund Amount(-) : 0.00

Total Billed Amount (B) 2580.70

Gross Amount (A-B) 0.00

Total Discount Amount(-) 0.00

Total Deduction Amount(-) 0.00

Total Balance Amount 0.00
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