JANTA HOSPITAL

Bill No: 102748 Bill Date: 15th Oct 2019

Harsh Chunara
Name of Patient________________________________________________________________, M
Age/Sex______,

Vasna, Ahmedabad
Address_____________________________________________________________________________________,

12th Oct 2019 15th Oct 2019

Date / Time of Admission____________________________, Date / Time of Discharge_____________,
Kamal Shah
Name of Treating Doctor____________________________________, General
Department________________,

Accommodation Type______________________________________, Room No___________________,

Viral infections fever and cough
Diagnosis:___________________________________________________________________________,

Code Billing Heads Rate Quantity Amount in Rs.

1 Room Rent 2000 1 2000
2 Nursing Charges 500 1 500
3 RMO Charges
4 IV Fluids Administration Charges
5 Blood Transfusion Administration Charges 1000 1 1000
6 Injection Charges
7 Similar expenses as Above
Total Room Rent Services 3500
1 ICU Rent
2 ICU Nursing Expenses
3 ICU RMO charges
4 IV Fluids Administration Charges
5 Blood Transfusion Administration Charges
6 Injection Charges
7 Similar expenses as Above
Total ICU Services
1 Surgeon Charges
2 Anesthetist Charges
3 Medical Practitioner Charges
4 Consultants Charges
5 Specialist Charges
Total Professional Fee
1 Anesthesia
2 Blood
3 Oxygen
4 Operation Theater Charges
5 Surgical Appliances
Code Billing Heads Rate Quantity Amount
66 Medicines and Drugs 2500 1 2500
77 Diagnostic Materials
8 General Investigations
9 Specialized Investigations
10 Dialysis
11 Chemotherapy
12 Radiotherapy
13 Cost of Artificial Limbs
14 Cost of Implants
Total of Other Expenses 700 1 700
Grand Total 6700
Patient Paid Amount 6700
Balance 0