Mobile No :, . Email :minthospitals@gmail.

com
PAN NO:AAKCM6077A / TAN NO:CHEM17453C / CIN NO:U74999TN2016PTC112873

Patient Bill
Patient ID : 200200079 Address : NO 4 B /7, MANTHAVELLY ST Admit Date : 07/02/2020 2:02PM
ARUMBAVUR POST
Patient Name : Mrs.GAYATHIRI CHINNASAMY Dis.Date : 12/02/2020 2:23PM
VEPPANTHATTAI ,
Age/Sex : 25/Female PERAMBALUR,CHENNAI , Ward Type : SRAC
621103 TAMIL NADU,INDIA
Mobile / Phone No : 7639756254 / Ward No : 308

Consultant Name : VENGADESWARI,MD DGO IP Bill No : IP/609/2019-20

Payment Type : Insurance Insurance Name : MEDI ASSIST INDIA TPA PVT LTD

Patient ID : 200200079 Patient Name : Mrs.GAYATHIRI CHINNASAMY Admit Date : 07/02/2020

Date Service Amount

WARD CHARGES
07/02/2020 BED CHARGES 2450.00
07/02/2020 DOCUMENTATION CHARGES 300.00
07/02/2020 BED CHARGES 3850.00
08/02/2020 BED CHARGES 3850.00
09/02/2020 BED CHARGES 3850.00
10/02/2020 BED CHARGES 3850.00
11/02/2020 BED CHARGES 3850.00

WARD CHARGES Total : 22000.00

SERVICES
07/02/2020 ECG 400.00
07/02/2020 SKIN PREPRATION 100.00

SERVICES Total : 500.00

OT UTILIZATION CHARGE
07/02/2020 MAJOR OT 9000.00
07/02/2020 OT NURSING CHARGES 1000.00
08/02/2020 LAPAROSCOPY INSTRUMENTS 7500.00

OT UTILIZATION CHARGE Total : 17500.00

LAB
07/02/2020 BLEEDING TIME ( BT ) 100.00
07/02/2020 CLOTTING TIME ( CT ) 100.00
07/02/2020 HAEMOGLOBIN ( HB ) 250.00
07/02/2020 ANTI HIV 1 & 2 450.00
07/02/2020 HBS AG 450.00
Day Total 1350.00
10/02/2020 COMPLETE BLOOD COUNT ( CBC ) 450.00
10/02/2020 RENAL FUNCTION TEST ( RFT ) 300.00
Day Total 750.00

LAB Total : 2100.00

IP CONSULTATION
Patient ID : 200200079 Patient Name : Mrs.GAYATHIRI CHINNASAMY Admit Date : 07/02/2020

Date Service Amount

09/02/2020 Dr. SURGEON . 26000.00

09/02/2020 Dr. ASST SURGEON I . 15000.00
09/02/2020 Dr. ANAESTHETIST ANAESTHETIST 6500.00
11/02/2020 Dr. PRABAKARAN UROLOGIST 2000.00

IP CONSULTATION Total : 49500.00

PHARMACY
07/02/2020 PHARMACY CHARGES 982.00
08/02/2020 PHARMACY CHARGES 2253.00
09/02/2020 PHARMACY CHARGES 8181.00
10/02/2020 PHARMACY CHARGES 2663.00
11/02/2020 PHARMACY CHARGES 604.00
11/02/2020 PHARMACY RETURN NOTE -384.46

PHARMACY Total : 14298.54

Total : 105898.54

Discount : 10450.00

Rounded Off : 0.46

Total : 95449.00
Amount to be Received : 30240.00
IP ADVANCES
12/02/2020 2019-20/1129 10000.00 CASH
12/02/2020 2019-20/1130 55209.00 CARD

IP ADVANCES Total : 65209.00

Bill Prepared by : SELVI

Bill Checked by : Admin

Authorized Signatory