Purnima Shah
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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
address :
9/a, divyakunj apt, gokhale road, model colony,, pune, pune, maharashtra, india
purnima mukund shah
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
4
microbiology
5
special test
6
diet consultation
7
administrative charges
60.00 400.00 6,500.00 200.00 1,316.00 section total ---------
14,476.00
pharmacy bill 8
pharmacy charges
1,067.38 section total --------grand total ------------
1,067.38 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
group total ----------
5,000.00
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
group total ----------
60.00
60.00
microbiology culture & sensitivity urine
1.00
400.00
group total ----------
400.00
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
group total ----------
200.00
200.00
administrative charges administrative charges
1.00
group total ---------section total ----------
1,316.00
1,316.00
1,316.00 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 ---------section total ----------
1,067.38 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 :
prepared by
checked by
15,543.00
authorized by
0000642
bill no :
000001335
ip no :
i-001187
bill date :
14-sep-2007
consultant :
dr. anantbhushan ranade
name :
mrs
address :
9/a, divyakunj apt, gokhale road, model colony,, pune, pune, maharashtra, india
purnima mukund shah
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
4
microbiology
5
special test
6
diet consultation
7
administrative charges
60.00 400.00 6,500.00 200.00 1,316.00 section total ---------
14,476.00
pharmacy bill 8
pharmacy charges
1,067.38 section total --------grand total ------------
1,067.38 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
group total ----------
5,000.00
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
group total ----------
60.00
60.00
microbiology culture & sensitivity urine
1.00
400.00
group total ----------
400.00
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
group total ----------
200.00
200.00
administrative charges administrative charges
1.00
group total ---------section total ----------
1,316.00
1,316.00
1,316.00 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 ---------section total ----------
1,067.38 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 :
prepared by
checked by
15,543.00
authorized by
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