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Final Bill

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Packages
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# Department Charge Group Charge OP/IP Cost Qty Amount
Dr.
s
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Pharmacy Services
# Category Product Rate Qty Amount
(discount from pharmacy)
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Laboratory Services
# Lab name Lab Code Charge Qty Amount
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Gross Amount
Discount
% ₹
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Discount In Amount
Discount In Percentage ()
Insurance Covered
Net Amount
Total Amount Paid
Total Amount Due
Total Refund Due
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Final Bill Report

FINAL BILL

Bill No : Admission No Appointment No :
Bill Date : Admission Date Appointment Date :
Patient Name : Father/Husband Name :
Doctor Name : Department :
Admitted Ward : Discharge Date :
Address : Kothrepally, Vikarabad, Telangana UMR No :
Hospitalization Charges From To
Packages
# Package Name Qty Amount
General services
# Department Charge Group Charge Rate Qty Amount
Dr.
Pharmacy Services
# Category Product Rate Qty Amount
(discount from pharmacy)
Laboratory Services
# Lab name Lab Code Charge Qty Amount
Gross Amount
No Concession
Concession Amount
Concession Amount ()
Net Amount
Total Amount Paid
Total Amount Due
Total Refund Due
Total Received Amount in Words
:
Total Due Amount in Words
:
Total Refund Amount Pending in Words
:
Gross Amount in Words:
:
Net Amount in Words:
:
Receipts
Receipt No. Date & Time Payment Payment Mode Amount
Refunded
Refund Pending
Advance
Paid
Total
(Authorized Signatory)

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