Patient Detail : Registration Date:

Tahira Shahid 27 (Y) / Female 18-Jun-2022 21:19

Mobile: Reference:
Patient Support Programme Lahore General Hospital Lahore LGH (CLL-Cash 59001)GOVT.
03009441009
Standard.
Registration Location: Consultant:
Patient Number: 59001-22-10196366
Lahore: Beside Lahore General Hospital . Case Number: 59094-18-06

Patient Bill
Sr. Test Name Reporting Date & Time Rate
1 Plasma Glucose (Random) Jun 19, 2022 - 13:20 300.00
2 Thyroid Function Test-2 (T3, T4, TSH) Jun 19, 2022 - 13:20 3300.00
Serum Total T3, Serum Total T4, Serum TSH
3 Serum LH Jun 19, 2022 - 13:20 1650.00
4 Serum FSH Jun 19, 2022 - 13:20 1800.00
5 Serum Total Prolactin Jun 19, 2022 - 13:20 1750.00
Serum Monomeric Prolactin, Serum Prolactin
6 Serum Total Testosterone Jun 19, 2022 - 13:20 1650.00

Total : 10450.00
Less : 2.50
Discount : 1567.50
To Be Paid : 8880.00

Paid : 8880.00

Registered By : Farhan3905

Collection Center

Center Name : Lahore: Beside Lahore General Hospital

Phone Number : 0345-4005428,0345-4005427

Email : lgh.59001@cll.edu.pk

Contact Person : Naveed Mukhtar

Address : Shop#1 Khalid Aziz Market, Beside

Lahore General Hospital, Main
Ferozpur Road, Lahore
I HAVE READ AND UNDERSTAND THIS CORRESPONDING TEXT AND HAVE ASSUMED ALL RISK(S) INVOLVED IN PARTICIPATING IN THIS TESTING. I RELEASE AND HOLD HARMLESS
CHUGHTAI LAB AND ANY AUTHORIZING PHYSICIAN, INCLUDING THEIR EMPLOYEES, AGENTS AND CONTRACTORS, FROM ANY LIABILITY, CLAIM, INJURY, DAMAGES, ATTORNEYS’
FEES OR HARM OF ANY NATURE THAT MIGHT RESULT FROM THE TESTING, MONETARY OR OTHERWISE, INCLUDING THOSE INVOLVING MY PHYSICAL OR MENTAL HEALTH,
MEDICAL TESTING PROCEDURES, ERRORS IN TEST RESULTS. IN ADDITION, I HEREBY CERTIFY THAT ALL INFORMATION LISTED ON THIS FORM IS TRUE. I UNDERSTAND THAT ANY
OBJECTIONS/EXPLANATIONS IN THIS REGARD CAN ONLY BE MADE/ASSERTED THROUGH ELECTRONIC MAIL ADDRESSED TO CHUGHTAI LAB AT “info@chughtailab.com” WITH
SUBJECT LINE TITLED AS “OBJECTION TO WAIVER OF TEST”, AND THAT ABSENT SUCH AUTHORED DIGITAL MAIL WITHIN THREE DAYS OF RECEIPT OF SAME, ALL OBJECTIONS
ARE/SHALL FOREVER WAIVED.

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