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Landmark Polyclinic
12/4, Paud Road, Kothrud, Pune - 411023.
Ph: 0202526245, Timing: 09:00 AM - 02:00 PM, 05:00 PM - 09:00 PM | Closed: Menday

Dr.Onkar Test
MBBS | Reg. No; T123 | Mob. No: 9421262709

Patient Details: Patient UID: 17

TEST PATIENT. (Male) Bill No: 2018/10/T729861
Age: 45 years Bill Date: 23-Oct-18
Admission No: 000008
Payer Deatils: Admission Date: 22-Oct-18, 10:20 AM
Name: TEST PATIENT Discharge Date: 23-Oct-18, 6:30 PM
Address: 405, Decent Recidency, MG Read, Pune Bed No: ICUO01

Consulting Doctors:
~ Dr. Shaunak Sule (Plastic Surgeon)
~ Dr. Bharat Purandare (Infectious Diseases Practitioner)

BILL SUMMARY
Sr.No. Primary Code Particulars Amount
1 100000 Room & Nursing Charges 2350.00
3 500000 Professional Fees 1200,00
4 400000 Medicine & Consumables 450.00
5 600000 Investigation Charges 430.00
6 800000 Miscellaneous Charges 720.00

Total Bill Amount: 5150.00

Amount Payable: 5150.00
Amount Paid: 5150.00

DETAILED BREAKUP
No. Code Date & Time Particulars Rate —_— Units Amount
1 100000 22-10-18 10:20 AM Bed Charges - PRIVATE 1000.00 11/4 1250.00
(PRIOD1)
2 100000 23-10-18 1:30 PM Bed Charges - (CU 2000.00 1/4 500,00
(ICU001)
3 500000 22-10-18 11:30 AM Dr. Shaunak Sule 100.00 1 100.00
(EMERGENCY)
4 500000 22-10-18 7:30 PM Dr. Shaunak Sule 500.00 1 500.00
5 500000 23-10-18 12:30 PM Dr. Shaunak Sule 100,00 1 100.00
(EMERGENCY)
6 s00000 23-10-18 1:15 PM Dr. Bharat Purandare 500.00 1 500.00
7 102001 -- Nursing Fees 120.00 2 240.00
8 102002 23-10-18 2:30 PM Dressing 80.00 2 160.00
9 102003 23-10-18 1:10 PM Nebulization 100.00 1 100.00
10): 102004 23-10-18 2:30 PM Injection Charges 50.00 2 100.00
11 = 401001 23-10-18 1:10 PM Ward Medicines 450.00 1 450.00
12 607000 22-10-18 10:29 AM Pathology Services 430.00 1 430,00
13. =801000 22-10-18 10:29 AM Admission Charges 500.00 1 500,00
14 = 802000 23-10-18 1:10 PM Attendant Food Charges 100.00 1 100,00
15 803000 23-10-18 1:10 PM Patient Food Charges 120.00 1 120.00
Net Amount: 5150.00

PAYMENT SUMMARY
Receipt No. Date & Time Amount Status Method
2018/10/745015 23-10-18 1:21 PM Rs. 5150.00 PAID CREDIT CARD

Patient's Signature

Authorized Signatory