final discharge bill

c. r. no : 0000642 bill no : 000001335

ip no : i-001187 bill date : 14-sep-2007
consultant : dr. anantbhushan ranade

name : mrs purnima mukund shah

address : 9/a, divyakunj apt, gokhale road, model colony,, pune, pune, maharashtra, india

company name self paying

discharge status recoverd

bed : dr507 admission date : 12-sep-2007

ward : deluxe unit 5th floor discharge date : 13-sep-2007

sr. no. particulars amount

hospital bill
1 indoor services 5,000.00

2 consultation charges 1,000.00

3 clinical pathology 60.00

4 microbiology 400.00

5 special test 6,500.00

6 diet consultation 200.00

7 administrative charges 1,316.00

section total --------- 14,476.00

pharmacy bill
8 pharmacy charges 1,067.38

section total --------- 1,067.38

grand total ------------ 15,543.38

in words :

fifteen thousand five hundred forty-three rupees

prepared by checked by authorized by

 hospital bill

name : mrs purnima mukund shah

bill no : 000001335 bill date : 14-sep-2007

ipd no : i-001187 c. r. no. : 0000642

description qty / no. of days rate amount

indoor services
room rent 2.00 2,500.00 5,000.00

group total ---------- 5,000.00

consultation charges
consultant visit charges / day 2.00 500.00 1,000.00

dr. anantbhushan ranade

group total ---------- 1,000.00

clinical pathology
urine routine 1.00 60.00 60.00

group total ---------- 60.00

microbiology
culture & sensitivity urine 1.00 400.00 400.00

group total ---------- 400.00

special test
chemotherapy 1.00 6,500.00 6,500.00

dr. anantbhushan ranade

group total ---------- 6,500.00

diet consultation
diet counseling (1st visit) 2.00 100.00 200.00

group total ---------- 200.00

administrative charges
administrative charges 1.00 1,316.00 1,316.00

group total ---------- 1,316.00

section total ---------- 14,476.00

 pharmacy bill

name : mrs purnima mukund shah

bill no : 000001335 bill date : 14-sep-2007

ipd no : i-001187 c. r. no. : 0000642

description qty / no. of days rate amount

pharmacy charges
avil inj. 2ml 1.00 3.20 3.20

cort-s inj 1.00 45.00 45.00

daxi -flow 1.00 124.00 124.00

dexasone 4mg inj 3.00 9.74 29.22

febrinil inj.2ml 1.00 8.50 8.50

gloves sterile 6.5 2.00 30.00 60.00

intracath (vasofix) no.22 1.00 80.00 80.00

iv set (intrafix) 2.00 50.00 100.00

lasix inj.2ml 4.00 3.24 12.96

needle no. 18 1 1/2 2.00 3.00 6.00

ns 250ml glass bottle 1.00 16.64 16.64

ns 500ml iv [ fr kabi ] 2.00 17.68 35.36

ns 9% 500ml glass bottle iv 1.00 21.84 21.84

palzen 0.25mg inj. 1.00 149.00 149.00

raciper 20mg tab 2.00 2.24 4.48

rl 500ml iv [ fr kabi ] 4.00 42.00 168.00

syringes [ dispo van ] 10cc 3.00 7.00 21.00

syringes [ dispo van ] 20cc 2.00 13.25 26.50

syringes [ dispo van ] 2cc 2.00 3.90 7.80

syringes [ dispo van ] 5cc 6.00 4.80 28.80

three way [ b braun ] 2.00 55.00 110.00

water for inj. 10ml 1.00 4.00 4.00

water for inj. 10ml 1.00 4.04 4.04

zinetac 150mg tab 2.00 0.52 1.04

group total ---------- 1,067.38

section total ---------- 1,067.38

bill details . . .

hospital bill 14,476.00

pharmacy bill 1,067.38

discharge bill amount : 15,543.38

net bill amount : 15,543.38

amount paid : 15,543.00

balance : 0.38

receipt details :

receipt no. receipt date payment mode receipt amount

000004076 12-sep-2007 cash 5,000.00

000004158 13-sep-2007 cash 10,543.00

total receipts : 15,543.00

prepared by checked by authorized by