In Patient Estimation

Admitting Location : BLK Hospital

Date of Admission : 16-January-2024

Expected Length of Stay(Up to) : 15 Day(s)

Estimation No. : BLKH/ET/207211 Ver. 0.2 MaxID : BLKH.1178375

Patient Name : Mrs. Aza Khalfan Khalifin Al Sharji

IPID : 141287 Current Bed Type : Single
Estimation Date : 22-January-2024
Company Name : IPS 50 (BLK)
Admitting Doctor : Dr. Puneet Girdhar

Sl.No. Service Name Economy

1 Debridement-Larg 97,241
e (Podiatry)
(Surgery)-100%
2 Room Rent 126,000

3 Consultation 35,000

4 Medical 92,500
Supervision
Charges
5 Equipment 30,000
Charges
6 Med Consumable 100,000

7 Other Charges () 90,000

8 Other Procedures 75,000

9 Pharmacy 50,000

Bed wise Estimated : 695,741

Total

Print Date : 22/1/2024 1:13:27PM Note: This is an approximate estimate based on historical data. It will vary on a case to case basis. Page 1 of 3
 In Patient Estimation
Admitting Location : BLK Hospital

Date of Admission : 16-January-2024

Expected Length of Stay(Up to) : 15 Day(s)

Estimation No. : BLKH/ET/207211 Ver. 0.2 MaxID : BLKH.1178375

Patient Name : Mrs. Aza Khalfan Khalifin Al Sharji

IPID : 141287 Current Bed Type : Single
Estimation Date : 22-January-2024
Company Name : IPS 50 (BLK)
Admitting Doctor : Dr. Puneet Girdhar

Sl.No. Service Name Economy

Deposit Amount : 708,216

Current Bill Amount : 732,522

Doctor Note :
USD-8382
Country-Oman

This estimation is only valid for next 10 days.

Our automated bill estimation engine is fairly accurate and last month data suggest that the final bill in case of 76.00 % of the patients provided estimates using the engine
were less than or equal to 110% of the estimated amount. Do note that the variation is generally due to prolonged stay, higher level of drug usage and unplanned procedures.
5% GST will be applicable on Room Rent.

Print Date : 22/1/2024 1:13:27PM Note: This is an approximate estimate based on historical data. It will vary on a case to case basis. Page 2 of 3
 In Patient Estimation
Admitting Location : BLK Hospital

Date of Admission : 16-January-2024

Expected Length of Stay(Up to) : 15 Day(s)

Estimation No. : BLKH/ET/207211 Ver. 0.2 MaxID : BLKH.1178375

Patient Name : Mrs. Aza Khalfan Khalifin Al Sharji

IPID : 141287 Current Bed Type : Single
Estimation Date : 22-January-2024
Company Name : IPS 50 (BLK)
Admitting Doctor : Dr. Puneet Girdhar

Sl.No. Service Name Economy

GST will be additional if applicable

PAN No. is mandatory in case of bill amount is more than or equal to Rs. 2 Lacs

Keshav Thakur

Patient Care Coordinator Patient Attendant Consultant

Print Date : 22/1/2024 1:13:27PM Note: This is an approximate estimate based on historical data. It will vary on a case to case basis. Page 3 of 3