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Family Details
Emp Code No 318332 S.No. Name DOB/AGE Relationship
Full Name GANGA RAM GANGA RAM 05.11.1969 SELF

Department/Division: ELECTRIC 2 REKHA 01.01.1979 WIFE

Basic Pay 18000/-7th CPC SHIVAM SAI 07.07.1999 SON

Entitlement GENERAL WARD 4 HRITIK 20.09.2000 SON

SINGH
Phone No. 9958710366
CARD NO. 22138
Residential Address: H.NO.2071,JANTA FLATS G.T.B
ENCLAVE DELHI-110093 DATE OF RETIREMENT / VALIDITY: 30.11.2029

Signature/Seal of the
Issuing Authority
Signature/Thumb Impression of the Municipal Council Cate of Issue
Empioyee
 HOSPL

SHRI RAM SINGH(APPROVED

HOSPITAL & HEART INSTITUTE
BY DELHI GOVT.)
B-25-26, 26-A, SWARANCINEMA ROAD, EAST KRISHNA NAGAR, DELH-110051
Tel.: 22003244, 22098463 Fax : 011-22092796 , For Appointment:8744043833
ESTD. : 1990 Helpline: 9311101768 Web.: www.srsh.co.in E-mail: srshhi @
gmail.com Reg. No. : 292

IPD ADVANCE RECEIPT

Token no
UHID NO 40023
Reg Date & Time :07/02/24 1.58 PM
Patient :Mr. GANGA RAM Mobile No :9958710366
Age/Sex :53 years Male Visit Type :First Visit
Org Name NDMC Consultant :CMO
Address :H.NO.-2071,JANTA Department :PHYSICIAN
FLATS,G.T.B,ENCLAE DELHI
Consultant : Dr. CMO
:350
Consultation Fee: 350
Discount: 0
Amount in words : Zero Rupees Only
Paid: 0

Due 350
FACILITIES :OB/GY, CT SCAN, ICU /Id6)RRSErY MEblcINE,SURGERY, VENTILATOR, CARDIOSLRAKA sTONEAiC
24 HOURS CHEMIST, COMPUTERISED LAB, 24 HOURS AMBULANCE, 24 HOURS AGH TECH 0.T.,
EMERGENCY, HIGH RISK PREGNANCY, ECHO COLoUR DOPPLER
ON PANEL :CGHS, DGEHS, MCD, DJB, DU, COAL INDIA, ALL PVT.
INSURANCE & CARD
NATIONAL INSURANCE, UNITED INDIA INSURANCE, NEW INDIA ASSURANCE, STARHOLDER, ORIENTAL INSURANCE,
HEALTHCARE &ALL I.P.A.
" YOUR PARTNER IN HEALTH AND ILLNESS"
 SHRI RAM SINGH(APPROVED
HOSPITAL & HEART INSTITUTE
BY DELHI GOVT.)
B-25-26, 26-A, SWARAN CINEMA ROAD, EAST KRISHNA NAGAR, DELHI-110051
Tel.: 22003244, 22098463 Fax : 011-22092796 , For Appointment : 8744043833
ESTD,:1990 Helpline: 9311101768 Web.: www.srsh.co.in E-mail : srshhi @gmail.com Reg. No. :292
PROCEDURES IPD ADVANCE RECEIPT
MR NO : 40023 BILL NO : 106376
PATIENT NAME: Mr. GANGA RAM BILL DATE : 07/02/2024
AGE/SEX 53 YRSI Male BILL TIME : 2.28.31 PM
ORGANISATION: NDMC
CONSULTANT CMO
S.No. SERVICECODE Procedures Name QTY RATE
1 BLOOD SUGAR BLOOD SUGAR RANDOM 1 28

Total Amt: 28.00

Net Amnt: 28
DISC REASON: opd
Disc Amt: 0
Total Paid Amt : 0
Due Amt: 28
JYOTISHARMA
FACILITIES :OB/GY, CT SCAN, ICU /ICCU,NURSERY, MEDICINE, BRARuYENTILATOR, CARDIOLOGY, LAPROSCOPY, STONE CLINIC, HIGH TECH O.T.,
24 HOURS CHEMIST, COMPUTERISED LAB, 24 HOURS AMBULANCE, 2 HOURSEMERGENCY, HIGH RISK PREGNANCY, ECHO COLOUR DOPPLER
ON PANEL : CGHs, DGEHS, MCD, DJB, DU, COAL INDIA, ALL PVT. INSURANCE &CARD HOLDER, ORIENTAL INSURANCE,
NATIONAL INSURANCE, UNITED INDIA INSURANCE, NEW INDIA ASSURANCE, STAR HEALTHCARE &ALL T.P.A.
"YOUR PARTNER IN HEALTH AND ILLNESS"
 SHRIRAM SINGH HOSPITAL & HEART INSTITUTE
(APPROVED BY DELHIGOVT.)
B-25-26, 26-A, SWARAN CINEMA ROAD, EAST KRISHNA NAGAR, DELHI-110051
Tel.: 22003244, 22098463 Fax : 011-22092796, For Appointment: 8744043833
ESTD. : 1990 Helpline: 9311101768 Web. : www.srsh.
LAR REOUISITION SLIPBLY Email : srshhi @gmail.com Reg. No. :292

UHID NO 40023
Date IPD ADVANCE RECEIPT
Months I Days
Age : 53 Ycarsl
213097 : Male
Req No. Sex
Mr. GANGA RAM : KRISHNA NAGAR
Name Location
DR. CMO
Ref. By Ürg. Name : NDMC
Mobile No 9958710366
NETAMOUNT
INVESTIGATIONS
SL.NO CODE
Rs: 230
1514 LIPID PROFILE.
Rs: 230
1559 T3, T-1, TSH
Rs: 150
1510 HB.\C TEST
Rs:
1608. X-RAYCHEST PA BEDSIDE

Payint Moct { ush

Total Amount
Amount P'aid in Wordis: Zero rupecs only Paid Amount
Discount Amount :0
Balance Amount : 805.00
KASHISH

FACILITIES :OB/GY, CT SCAN, ICUIICCU, NURSERY, MEDICINE, SURGERY, VENTILATOR, CARDIOLOY, LAPROSCOPY, sTONE CLINIC, HIGHTECH O..
24 HOURS CHEMIST, COMPUTERISED LAB, 24 HOURS AMBULANCE, 24 HOURS EMERGENCY, HIGH RISK PREGNANCY, ECHO COLQUR DOPPLER
ON PANEL :cGHS, DGEHS, MGD, DJB, DU, COALINDIA, ALL PVT. INSURANCE &CARD HoLDER, ORIENTAL INSURANCE,
NATIONAL INSURANCE, UNITED INDIA INSURANCE, NEW INDIA ASSURANCE, STAR HEALTHCARE& ALL T.PA.
"YOUR PARTNER IN HEALTH AND ILLNESS"
 KoA
HOSPIT
SHRI RAM SINGH HOSPITAL &HEART INSTITUTE
B-25-26, 26-A, Swaran Cinema Road, East Krishna Nagar, Delhi - 110051
Mob: 9911781 768. 9911071768, 9990901768, 9311101768
For Appointment:8744043833 Web. : www.srsh.co.in E-mail : srshhi@gmail.com
Date Name | Age
Sex
UHID
1 Duration
Clo Soß
-Sheeta
BP :Lo_mmHg. HR
:48min. RR /min. Temp. :16 1o°F
Pallor :+/ Pain Score (0-10) : Odema:+/
SpO,: Wt. Kg.
TREATMENT ADVICE M A Days
Present History:

Family History :

INVESTIGATION Atr
Refat

- yrutd robite 09

Ho A FOLLOW UP INSTRUCTIONS:
DIETARY ADVICE (IF REQUIRED)
Kosur
TNERS IN HEALTH AND ILLNESS"
Slyna 6 Doctor