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0% found this document useful (0 votes)
96 views23 pages

Img 20240308 0001

Uploaded by

sudarshan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
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STAR HEALTH AND ALI-IED INSUR,ANCE, COMPANY LIMITED

Regd. & Corporate Office; 1, Nevu Tank Street, Valiuvar Koltam High Road, Nungambakkam, Chennai - 600 034.
xealth Corporate Office - Claims Dept. : l'1o.15, Balaji Complex, White$ Lane, 1st Floor, Royapettah, Chennai - 600 014.
& earieg lnsuEoce Toil lree Phone No: 1 800 425 2255 Toll tree Fax l{o: 1 800 425 5522
CIN : 16601CT1120t5PtC056649 Enail;suppod@siarirealtlr.h Website: B*w.sarhealth.in lRBAl Regr. No: 129

CLAI[/ . PART-A

TO BE FILLED lN BY THE INSURED Ihe issue of this Fom is not to be taken as an admission of liahility Claim I 052
qLg
ai Fslicy ilo: r ql |\o. b-.lrd" \ .

c) Companyl IPA ID lls: 2oc-(2,aqeq-_1. I


tt

i9
tTl
dl Name:

e) Fddees :
2L

City: CPlrN^IA-I Stale:

ai Curently

cl ifyes,
covered

company name:
bI ary olher Mediclaim / Heallh lfis*racce: Y6
I*B b) Date sf comm*emefil

Policy
of tiBt

lto-
lnsrare willdt break:
iUE E@ EE (Copies ofPoli.ies io be atachdi)

m
c)
slnt*sadfii)- d,itkreysb@hcFih&editthek4y66? ys t{6 w-l-/-- Disgftos;sl i
2
e) Prwiously ryered bytryoltH Mediciaim /HElthinr* r rO,
fl no I iryes, C.ftpany fJas€
E
ffi

a)Nme:

b) Gender: Nafl r,*vfi S@ ***EE


")ns",y",*
dlDareorBirft: #-/fr/Jfug
e) Relaionship to s"ir
I
Pri@ryicslredl A**B chilc Falhs L{olhs ou [ {plimspe{ify}
a
1) 0@patioi: Sewie SsY EmployeC
I n"r**"rS u StJdat ReliEd ** f] P,B*sptri{y}
i
s)

:
cdv: S'6le:

Fir C.ode: Efail Ui

aJ Name olHospital whds Adnritted: Ns. of lP Eeds-L-


b) Rom Celego.y aopieii Da, *ie
E lw**u I rorwuspuwl=l
slreu*,e*ry d]klqtk torereao: u{rn il ,** [ M"er*ryB gt
m
d)Datecf rniuy/ratsoiwti.stdetectednaieotDdivrr
Ai-/ l&lflAa4 elDatedA&nissie: &-/-A& L&e-+ nll,"e: ?5, q<F',) 3
sloatearsisdulse: e!-/-Lg! /&Ay hlrre: O 6-, -W+r)+rtntu'ys;vetre: sdfisiigbd fl aar*x"t**ent fl sul*rceaarelAlshrlcownFre Tl
E
i.lt!.Idi@lesaii v*fl N"filr' ii.R€psdedtapolicei
f]v"" pd i*.HLCRepod&ruefiRatr.tedi
flv* fixa i]sFt€ner Hedcire.

a) Details of fie ireatrEnt expens claimed b)ClaimforDomioilia.y Haspitati",tion, Vo aniexurel Claim Doeuments 6ubhitted- Check Lisl:
fl I No {lfyes, pravide deiai,s in
i/Ciaim Fom Duly sig^ed
j- Pre&6sp?faB&f*s
ryM: RS. lboc)o .) &!6ih of LusFsffi a €$r beei* dained;

Re p13
li4opy ol ttre dain intiluatiB
ii. Hospr'lalialon Expffi : Rs i. HosSaJtailyC6h: Rs.
fl/ffosplbl Maio El
giil
iii. Post"lbsFihliz.tis EryeG*l Rs. i. Ssruicd Caslr: Rs. U/tlqspihl SEak{p

iv. H@ff!€heet( $ C6rt R$" i[- S*@l Fne Besefi] *s"


filHospital Bli PaFreit F:ffiipa a
El
i-'t{06}ihi Olslrarge SrffiBy r)
v. Asbufr@ Chqg*: Rs- iuCtrulesffi R& j..Phffiacy sifl {
t{oes o
!i. OrEs {Eode}: Rs. { Pre,FoS h6?it*zatioo Lmp s bsefr: Rs.
l?tFem!'eIh6eE Z
Tsal

vii. Preh6pilaEldi6 peiad:


R$

da16
liOfffi:

T.dal
t]IT] k
Rs, lr.ttq , o1z
[]
fl
Dodot'sequ*tfdinvsligalion
ECc
lostigatid Reporls {lnduding CT
m

!- Ii/R]i USG/HPR
!iii. Pst*!6pEd@6qpstd days Doctry'sPrwnilirc
i]
fl orrers

SI, NO Bill No Date lssued by Towrds Amout {Rs)


1. I D9, e.)t,, .- tl47 q ,r) ,! a l*p e,rfu t [b,prn b*i Gnrra Hospital Main Blll
6 b .S t) o
2. B 5 il Pre-hmpitalialion B$1$ t Nos
I l, D o o
D B Posltlspilaliratis Bilis: Nos

4. D o Phlms.y Blils
I q 1 a
il
o
5. o D {o
6. D
z
D o t{ N 11
7

8. ts E !1

L D D

10 a

a'**ffiffi@EEtr o tr tr tr blBakA*entNumbs
mE tr B tr m E E tr gE E m E B I
II
.) BBtrk Nene and BBnch: \ NE ENTU I v u trgtrEgitE A K t]EtrEtrgilNHtrU + NEEJc+
d) Cfeq{eiDD Pa}abie C*tails: ", el,Fsccods
til fol [4 tAl ]tl I0l itl I El4t[clnnflnn o
Health
& Cnridts in5urance

DECLARAT'OH BY TflE
'NSURED:
I hereby declare ihat the infonration furnished in this claim lornr is true & coffect to the besi of my knowlecige and Lrelief. if I have made any false or untrue statement.

medicai information ,'rjoCilments lronr any hospital / fuledical Practitioner who has attended on lhe person agaifst wlrom this claim is made. i hereby declare that I have m
included all the bills 1 receipts for the purpose of this claim & that I will not be making any supplementary claim except the prelpost-hospitalization claim, ii any- ()
i
o
Z
J

o.rc, f6tE Etrl trtE Pla.e: "a-f alt iiJ'D i Siqraiure of lhe Insured I
GUIDANCE FOR FILUNG CLAIM FORM - PART A {Te be filted in by the insured)
DATA ELEMEI'IT DESCRIPTION FORMAT
SECTIOI,I A. DETAILS OF PRTi'IARY INSURED
a) Pcircy No. Enter the policy nuorlter As allotted by'lhe insrrance cmpany

b) Sl. Noi Certificate No.


Entea lhe social insuranft fiumber or the cefrificate number of
As allotted by ihe organrzation
social health insurance scheme
c) Conpany TPA lD No. Ente{ Lhe TPA lD Nc
Llmnse nrmher as a,lotted by IROA and
prinled in TPA dsuments.
d) Name Enter the fuli name ol the policyhoide. Sumame, Firsl name, Middle ffanre
e) Address Enter lhe full postal address lnclude Street. Clty and Pin Code
SECTTON B . DETA'LS OF INSUBANgE }IISTORY
a) Currenlly coyered by any other Mediclaiin / Heallh lndicate whethe. currentl:, qoyered by another Medidaim /
lnsuraflce? Tirk Yes or No
Health ltrsurance
bl Dale of Conmencement ct li6t lnsuranm withoxt t].eak En'ler lhe date of cffimenBment of first insurance Use ddam-yy formai
c) Company Name En'ler the full name ol the insurance company Name ol the organizalion in full
P€*cy H$. Enler the policy nusber As alkltted by ihe insurance company
Sum lflsured Enier the totai sum insured as per the poiicy ln rupees
di Haye you been Hospiialized in the last 4 yea6 lfldicate whether hespiialized in lhe last 4 years Tick Yes or No
Date Enler the daie of hospitalizaiion Use mtr-y./ iomal
Diagnosis Enier the diagnosis delails Open Texl
e) Previously Covered tiy any other il.,lediclaiml Health lndicate whethe. previously covered by another [Iedicieim /
16surarre? T,ck Yes or No
Health lnsurane
I Csmpafly Name Enler the iull name of tlie insurance cBmpany Nanre qf ihe organizatiM in full
SECTIOII C - DETAIL$ OF IHSURED PERSCI'; HOSPITAUZED
a) Name EBier the full name of the patiert Sumame. Firsl name. Middle name
ir) Gender lndicate Gender of th* patient f;ck l'iale or Fenale
c) Age Ente. age 0f the patient Number of yearu and months
d) Date oi Blrth Enter Oale of Bilth cf patlefil Use dd-mn-yy ismat
e) R€laticnship to primary lnsured lndicate relationship af patient with policyholder Tick the nght optaifi. It othcrs. ptease spe6ify.
f) Occupatisn irCicale orcupatioo of palient Tick the right option. lf others, please speqify.
g) Addrss Enter the fuli postal address lnclude St.eet, City and Pin Code
h) Phone No Enter the phone ftumber 0t pa{ient l[clude STD code with lelephone number
i) E-mail lD Eoter e-mail address of patient Complete e-mail address
SECTION D - DETAILS OF HOSPITALIZATION
a) Name of Hospiial where admi{ed Enter lhe name of hospiial Name of hospiial in full
b) Roofr 4ategQry occupied lndicale lhe rcom categgry occupied Tick the righl optian
c) Hspitalialion due to lndi€te reason 6i hospiializatiqn Tick lhe right aption
d) Date cl lnjurylDate Disease i.st detected/ Date of
Enlef lhe rele.Jani date Use dd-mm-)y {ormat
Delivery
e) Date oi admission Enter daie o, admissiorl Use dd-mm-fy iormat
f) Time Enter ime of admission Use hh:mm format
g] Date ci discharge Enter dale oi discharge Use dd+m-yy iormat
h) Time Enter lime ol discharge Use hh:mm format
i) li ltrjury giye EUSe lndicate cause ol injury Tick lhe right option
lf MeCico legai lndicate whether iniury is tr9dico legal Tlch Yes or No
Repoited to Pslice lndicate whether police report was {iied Tick Yes 0. No
MLC Reporl & Police FIR altached lndicate wheiher MLC report ild Police FIR altached Tick Yes or No
j) Syslein of Medicine Enter the system oi nledicine foliowed in treatinq the patienl Open Text
SECTION E - [}ETA'L$ OF CLAIM
a) Details ofTrealment Expenses Enler the amounl claimed as trealment exF,enses In rupees {Do not enter paise values)
b) Claim for Domiciliary Hospitalization lndicate whether claim is Ior dcmiciliary hsspilalazatior Tick Yes or No
c) Details of Lump sum/ cash beneiit claimed Enter lhe amouni claimed as iump suml cash benefit ln rupees (Do not erter paise values)
d) Claim Documents Submitted-Check List lndicate which s!ppsrting doftments are submiited Tirk the right option
SECTION F . DETAILS OF BILLS ENCLOSED
lndicate utrich bills a.e enclosed with tl-€ aBounts in rupees
SECTIOH G . I]ETAILS OT PRIful}.RY INsT]RED'S tsAN( AC'OUNT
a) PAN Enier the perman€nt acccunt rufiber As 3llctted by ihe lncome Tax depadnrent
t]) Atrount Number Enler the bank account nunlber As allotted by the bank
c) Bank i\lame and Branch Enter the ilank name altrg wih the bmnch l{ame af the Bank ln full
Enter the rame ol the beneficiary lne cheque/ DD shculd be
d) Chequei DD payable details Name oF the individual/ organization in full
rirde out to
B) IFSC Code Enter the IFSC code of the bank bra*ch IFSC code of the bank branch in fuil
SECIION II . DECLARATION BY THE INSTIREI)
r.'i g\ {- 4l "fl ! . h rn A I E l[*r\ l\If,0 Fft a hrrr fnLln A Al1, E ,E jtfrh
,#[ 3 i /aK mf,1.-L ! fi n tcu p{_LLtEt,t Bi\JLsR1-tlq\-L q*LJlvdr'jaiq i i-ii\-ii }r LEi
h ReSd. & Coryc#te *iaiiie: 'i. Fieyr' Talik Strset, \,'al!uvar Koilarn High F-,cad, l.iil*95-.fftlaj&arn, Chennai - 601 034.
{:orpor?ie Offiae - Ci4ims }ciri. : No.J5" Bala.li Comolex. Whilis Lane. 1st Flooi Rc}iaDettah, Chennai - 600 Ui4-
F\f e.t..r. i:.'.,€ I lnsuBnEe Tali iree Fhnne tia: 1800 425 ?r55 Tsii iree F=i *ic; i $t* 4?5 5522
Cllt i L68;i$TN2C85FLC05564e Enreil:supp?n@slarleslfi-i1 !{ebsrle: w.ur:lsiheaith.irr IRDAI Regn. tio: 129

]O BE FILL€D B? ?HE I*OSPITAL


ih i-E ii hL icr-ni ji i,;: t 5. iE:i-i;::i ;i=:rr.r*i all::[:l+'Na.:.. p:11.e:l€ a:iiii=: ?.n3f;*s:tr-.1]= i..i=!r:n a lbtr / P,IPI i

ii !,leBe ri lrg

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Bi N3fie orlie Fanerl

bi tP Resisti*4n *enr*r, *O*[r*nr*ffi dr,lse vwamm **E,E +aaredloltr ZZ ,/-9n


ti Dale !f tuBtssacn: /S*14 c!.,,m: 06-, o. f * h! tatB s liisrBlge;
4/:9.-L /Jsry i ';'''" iDli5- i6l @i

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iv. C!{triifr*s; { f-1.-r--r---lr*rI-f-


it. Pipiedse 3:
I il_jr il ILil.l I

v- Dratioa of &w: .
,r C,
vi Pasi irledKai History I 0
,i B
Cl Preseni aim€d 6; *?pli#tis oiPaB? vs i] ero i*J itrr**.r"rVo*1
C) i,re-suthorireli.r el}ir!.. j: *[*Il e; Pre-i,rih:ii,1ii.1r i.li::rriari

li ll a1xhq6ic* b! €{if,rk l.Ei}*J ,r6i .}sirEd +re eew:

gl lisrla:cat4t ffi lo iqiii: r*[ r* ] i.iiYss,$affi


i;.- lf kjuy$.Ee S&*:#&tr taeed ffisH$stIsiC*rrbd A€*&ti&k:

,** ililIil[Iil, 1-:t] :; rI i:l .iir:ai€,i irl a:rili.:, !;.,i- i!:ii^r'

fi ga*fsrr&iyi*frg ll urcsg*mrep*r
il *ki!$FrB#dBia*BeqlBs I] CrffmilSe,qpEin$tErfs'F+m
[J CrpydtAenra*t*er #md+aer I Orii*s,*am*frhqe*ledan
n cw aguopartdsatiantvarifiEdty tE@
t/r**,*l*"g"*r.y
f] &mton"ttrmtar* =,v
fu/ HiaBaryt$
I MlciwreeesFR 53
tgf JhstilalmainB ij Wdriw*sxwryfw;m*A*srq*;af*
S/ NorpiraOrea,n+UH L eryss,@w*ry

slAd&€sd $eibrr&l

{r}

-.1

E
Siriel

FiflC:4e ll.r:::: 'i l ar R..ii;:a:;or.i:..

nj -AA: I i: :...jii; :ii: i i; :: r::r _::,:::;i


; ,:1 ,* ffii-l s,cr,'
",ffim[
i:4. $*s5

ftF.. A$indr sv t{t !^16r?ar

{J?
iii
Dare b,j(, 0f l4 : E r,
-
n
*n
Health
& CarinA l!$rran{e

I hereby declare that the infonnation'furnished in thls claim form is true & correci to the i:tesi of my knowledge and beliei. lf i have made any false or untrue statement,
suppression or c.fncealment of any material fact, my right 10 claim reimbursement shail be foi{eited. I also consent & authorize TPA / insurance company, to seek neDessary
tJt
ffiedical informatiorr I documents {rom any hospital./ Medical Practilianer who has attended on the person against whom this 0iaim is made. I hereLry declare that I have m
included all the bills / receipts for the pulpose of this 6laim & that I u/ill not be making any suppiementary claim except the prelposlhospitalizaliitn claim, if any. c}
Io
z
T

Dat., E@ @W@W Siqflature ot the lrsurail I


GUIDANCE FCR FILLING CLAIM FORM - PART A iTs be filled irr by the in$ured)
DATA ELEMENT DSSCRTPTION FORMAT
SECTION A . DETAILS OF FRIMARY INSURED
a) Policy Nc- Enler the policy number As allotted by the insurance company
Enter lhe soclal insuranE number or the ceriiiicate number ol
b] Sl. Ncl C€rtificate No. As allotted iry the organization
social health insurance scheme
c) CompanyTPAlD&s" Liceose number as allotted by IROA and
Erler the TPA lD N0
prin{ed in TPA docusenls-
d) Name Enter the fuil name of tlre polisyholder Sumame, First name- l,,liddle name
e) Address Enter the full pestal address lnclude Street, City alrd Pin Code
SECTION B. DETAILS OF IHSURAI.IGE HISTORV
a) Curentlv covered try any ather l,,ledlcJaim / Health lEdicate uhether curren|y covered by another Medidaim /
Insurance Tick Yes or l,lo
? Heaith lnsurance
b) Date oiCommencement cf iirst lnsuranre without break Efrter the date af commefrcement .rl lirst insuGne Use dd-mm-\ral forrflat
c) C0mpanv Nalne Enter the full name of the insurance company Name of ihe organization in full
Policy Nc. Eiiter the poiicy numller As alloited by fie insurance tranlpary
Sum lnsureC Enter the total sum insured as per the policy ln rupees
dJ Have yo5 been Hospitalized in llte iasi 4 yeare lildicate sfielher hospitalized ir the lasl 4 years Tick Yes or Nq
Date Enler the date of hospiializatioo Use mm-yy format
Diagnssis Enter the diagnosi$ details Open Text
e) Previously Coyered iry any other Mediclaimt Health lndicate whether previousiy covercd by another Mediclaim I
TiDk Yes or ND
Iilsurunce? HealtFr lnsurance
f) Company Name En'ter the iull name qf the insuEnce Com[ralty Nanre 0f the org3nrzation in full
SECTION C. AETAILS OF IlISURED PERS(}N HOSPITALIZEB
a) Name Enter the luli name 0f the patiert Sumame, Firsl ilame. fu4iddle name
b) Gender fuidicalf; Gnnder of the palieni Tick l\4aie or Female
c) Age Erter aqe Dflhe Ealient Number cf yea6 and months
d) Dale oi Bi,ii1 Enter Dale of Birlh sl palienl Use dd-mm-w flrmat
ei Relationship lo ptmar/ lrlsured lndisale relationshrp of patienl wlth pelicyholder Tick lhe right option. li othe.s. please speciry.
f) O€upation indicate occupation qf patiert Ti6k ttre right option. lf others- please specify.
g) Address Enter the f!il postal address lnclude Street. City and Pin Code
h) Phone No Ente. lhe phone number of palient lnclude STD code with telephone number
i) E-mail ID Enler e-mail address of patient Compiete e-mail address
SECTIO''I D. DETAILS OF HOSPITAUZATION
ai Name qf Hospitai y.ihere admitled Enter lhe name of hospital Narne of hospital in luil
b) RQom calegsry occupied lndicale lhe reom c€tegory occupied Tick the right option
c) Hospitalialicn due t0 lndiEte reastr ot hospitalizatjcn Tick lhe righl option
d) Date of lnjurylDate Disease first detected/ Dale of
Enler the relevani dale Use dd-mm-yy format
Delivery
e) Dale 0fadmission Erter date ol admission Use dd-mm-yy lomrat
f) Tinre Enler time of adntissicn Use hh:mm fomat
g, Date sf discharge Enter dale of discharge lJse dd-mm--vy fo.mal
h) Time Ester lime 0f discharge Use hh:mnr format
i) l, lnjury give cause lndicale ffiuse of jnjury Tick the ight option
lf Mediao legai lndicate whether iniury is medico legal Tick Yes or No
Repo{ed to Police lndicate whether poliee repart was filed Tick Yes or No
MLC Rerrort & Palice FIR aflached lndicate khelhe. MLC repo{ anC Pollce FIR attach"d Tick Yes or No
j) Systen of l!,ledicine Enter the system of medicire followed in treaiing the patient Oper Text
SEGTION E , DETAILS OF CLAIM
a) Delarls o'lrcdlmenl Expeose; Enler the amount claimed as lreatment expenses ln rupees (Do not enler paise values)
b) Claim fsr Dotrrieiliary HosFilalizaiion lndicate uhelher claim is lor damiciliary hosoiiaiizaticr -fick
Yes or l\io
c) Details oi r-ump suml cash benelit claimed Entet the amounl c"laimed as lump sdm/ cash bef;efit ln rupees {Do not enter paise yaluesi
Oi Claim Do.uments Sqbmitted-{lheck U$t lndioaie wtrich suppo,ling documents are submiited Iick the rclrt oplioo
SECTIOiI F . DETAILS OF B'LLS ENCLOSED
lndicale lvhi.ir bills are enclosed $th lh€ af,tourlts in rupees
SECTION G - DEIAILS OF PRIMARY INSURED's I]AI.lK A'COUNT
ai PAt$ Enler the permaneni sccoufil numbet As allotied by ihe lnccne
-fax
depa,-t.ient
b) ArEuft liumber Enter the bank account number As alletted by the bank
ci Bank Naqe arxJ Bra0cll Enter th-- bank ffaflre aloilq lvillt flte ilranch Nanle of the Baflk fi full
Enler the name of lhe benefiCiary th€' chequel DD should be
d) Chequel DD payable details Name of the individuall organization in full
made lut to
e) IFSC Code Enter the IFSC code af the bank brarch IFSC code of the bank branch in full
SFCTtOltl H . nFCt ARATION RY THf lilsl leFn
Lqkshmi Ferlility Cenlre
Dr. K. Jothiganesh rrrees., D. ortho
ergrLbr.lgldlq a grr@ unlE otOI6Dor dl66eoe LoO6grorn
Visiting Hours : 9.00 am to 9.00 pm

Dr. Pakkialakshmi Jothiganesh M.D.(oc)., DNB (oc)


t-oouGugl .pgrb 1gp$opu5leoreoro dlgluq roOji5lorn
Visiting Hours : 9.00 am to 9.00 pm

Name: ....... sex: Date


DISCHARGE SU]fffi{ARY
: MRS.S.M,SHARMEE
@^ffi'ENTNAME : 3BIFEMALE
IP NO : 05489/7L20
ADDRESS : W/O MR.SUDHARSAN.S
NO:26 / 7, RAGHAVA NAGAR, 1ST STREET,
CHROMPET, CHENNAI-44.

DATE 0F : 26.02.2024
ADMISSION TIME:05.35 PM
DATE 0F SURGERY : 26.02.2024 TIME:09.07 PM
DATE 0F DISCHARGE : 29.02.2024 TIME05.00 PM
PROCEDURE : EMERGENCY LSCS DONE
INDICATION PRIMI/ELDERLY SHORT GRAVIDA/USG FINDINDS OF CORD THRICE
AROUND THE NECK/MOBILE HEAD @ TERM IN LABOUR
CONSULTANT : DT.PAKKIALAKSHMI IOTHIGANESH M.D.(O.G).,DNB[o.GJ[MRCOG]
DR.HEMALATHA M.D.IPAED) DNB.,
DR.ARTVAZHAGAN M.D. IPAED).,
DR,SHANKAR M.D (Anesthesiology)
Under Spinal Anaesthesia abdomen was opened through SPT incision; LSCS
done in usual way an alive term BOY baby was delivered
which cried immediately; cord clamped & cut
, Inj.synto 20U added to the drip; placenta with membranes delivered in toto; uterus was closed with 1-
vicryl ;after perfect hemostasis secured;abdomen was closed in layers; clear urine draining at the end.

TREATMENT:
AIive 1. IVantibiotics
Term Inj.Piperacilin&Tazobactam 4.5gm
IV Bd
B BOY
Inj.Metronidazole 500mg Bd
A Baby wt:2.6kg Inj.Pantoprazole 40mg Bd
B 2. Analgesics
Y B/70,9/70 Inj.Paracetamol 100Omg IV Stat
Inj.Tramadol 5Omg IMStat
Inj.Promethazine 2Smg IM Stat
3. IE Prophylaxis given.

DATE: 26.02.2024
TIME: 09.07 PM
Mother blood group:B+ve
Baby blood group :0+ve

Ph : 04565 - 40079'!, Mob : 98S43 31474


-1

- Post operative period was uneventful


- dressing changed on 3rd POD; wound healthy'

DISCHARGE ADVICE:
- Review after 1 weeks
- T. Ceffix 200mg (1-0-1)
- T. Metrogyl400mg (1-0-11 7 Days
- T. Aceclofix sp (1-0-1)
- Cap.Raberas D (1-0-1)

H
pr. PAKKIA!5EIH J glstgiNEs

'*!*"*$'ffi*.i*IftHtr'

I
I

NEN
RflJ
Computerized Clinical Lab
No - 7, T.T l{agar, {st Street, {Near subalakshrni Pa!ace}, Karaikudi - 0 'l

Tel: 04565 232477,400234 I Mob: 9244532021 [ Ernai!: newrajlab@grnail.corn

CASH / CREDLT BILL


ar 4 nnnTnao
Pt. i\iame : MRS,S.M.SHARMEE Biii irio ZJIUUU'YZJ

Ane / qev.39/Female Bill Date 04-10-2023 04.14 pm

Ref B;'. : PAy.K,ALAKSHIJII .tJD,OG i llllll llil ilIil ilfl illt ililt ilil ffr
I tiltil iltil flIil ll1r itilr ilIfi iril llil
Towards
S,No Sample Test Details -Amount
1 BLOOD NIPT 16000

Total 16,000
Rupees sixteen thousand oniy I/lis.Cnarge 0

Less 0
Net Amount 16,000

Paid 16,000

Balance 0

Fon New Ra.i


NEW INICAI IA6
N0.6, AR
T.T. St STREI:
Near SUIBALAKSH PALA.
KARAIKUDI - 630 00r
kii 324a5320et,pti,O+SOl :: -
f int hmps://mocdoc.in ibilling/ipbill/print/lakshm i-fertility-centre/laksh...
'
Lakshmi Fehility Centre
#5,Church 2nd St,TT Nagar, Karaikudi--63000 1

Phone:9894331474
$"m[*skmi S*r&iiitrE {**tre
;*r'e,dr oqn $4,#iil osu,*ri,

lP Bill Cum Receipt


IP No 1120 Bill No 1P2324-1137
Consultant Dr. PAKKIALAKSHMI M.B.B.S, Date 291021202419:02
M.D(OG)., DNB(OG)
D.O.D 291021202417:00
D.O.A 261021202417:30
D.O.Dt 261021202421:07
D.O.S 2610212024 20:50

Name ID Age Gender Mobile


Mrs. S.M.Sharmee S.Sudharsan LFC-9235 38 years F 9894823566
Payment Type: Cash

Particulars Qtv Amount Total

MEDICINES

Pharmacy Bill - PHARM 2324-39307 1 12888.00 12888.00


Pharmacy Bill - PHARM2324-39435 1 880.00 880.00
Pharmacy Bill - PHARM 2324-39449 1 7520.OO 7520.00
Pharmacy Bill - PHARII 2324-39492 1 164.00 164.00
Pharmacy Bill - PHARM 2324-39496 1 81.00 81.00
Pharmacy Bill- PHARM2324-39641 ' 1 93.00 93.00
Pharmacy Bill - PHARM 2.324-39647 1 71.00 71.04
Pharmacy Bill - P HARM 2324-39663 1 137.00 137.00
Pharmacy Bill - RETPHARMZ324-387 1 (-)2e7.00 (-)2e7.00
Pharmacy Bill - PHARM 2324-39704 1 56.00 56.00

OTHERS

THEATER CHARGES 1 10000.00 10000.00


lnstrument Charge 1 3500.00 3500.00
Consultation Charge 8 500.00 4000.00
SURGEON CHARGES 1 15000.00 15000.00
Asst. SURGEON CHARGES 1 8000.00 8000.00
Nursing Charge 4 500.00 2000.00
BED CHARGES 4 2000.00 8000.00
ICU CARE 1 6000.00 6000.00
Warmer Charge 2 1000.00 2000.00
OXYGEN CHARGE 1 1500.00 1500.00
Pediatrician Fees 1 1500.00 1500.00
Anaesthetist Fees 1 5000.00 5000.00

Total: 88093.00
Advance On 2610212024 20:42: 6500.00
Advance On 2710212024 18:51: 50000.00
Advance On 2910212024 19:02: 10000.00
Amount Receivable: 21593.00
Amount (in words): RUPEES rwENry-oNE rHousAND rve uuruohffi,6ffif{UHryE{qqqt,lT\f ,fiHf,jT$tffi
ONLY Amount Received: 21593.00
Iti ,;.S, ;" i.-, r , ' i , r't jl, l ,ri l,jE'i
-;

i :, i Authorizecl Sionaf r rrp


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Lakshmi Fertility Centre


#5,Church 2nd St, TT Nagaq Karaikudi--630001
Phone:9894331474

Advance Receipt
Names ID Age Gender Mobile
Mrs. S.M.Sharmee S.Sudharsan LFC-9235 38 years F 9894823566

IP No: tL20

Receipt No: Receipt_1t20_L

Amount: 6500.00 (RUPEES SrX THOUSAND FrVE HUNDRED ONLy)

Payment Type: Cash

Received By: Muthulakshmi

Received At: 26/02/2024 20:42

Authorized Signature
LA;;;J.t,i;i &--;;lTt; fry r.r-,
No.s, e nl '
'nc;i?ij.'u'#..i
1""T. Ir.: rf,tR l

KARAITUL,I_ e:i.l toL i


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Lakshmi Fertility Centre


#5,Church 2nd St, TT Nagar, Karaikudi--630001
Phone :9894337474

Advance Receipt
Names ID Age Gender Mobile
Mrs. S.M.Sharmee S.Sudharsan LFC-9235 38 years F 9894823566

IP No: 7t20

Receipt No: Receipt_1120_2

Amount: 50000.00 (RUPEES FIFTY THOUSAND ONLy)

Payment Type: Cash

Received By: Muthulakshmi

Received At: 27/02/2024 78:5t

Authorized Signature
'tfLr
1"r L-.

i.. r,, STR


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La ksh mi Fertility Centre


#5,Church 2nd St, TT Nagar, Karaikudi--630o01
Phone:989433L474

Advance Receipt
Names ID Age Gender Mobile
Mrs. S.M.Sharmee S.sudharsan LFC-9235 38 years F 9894823566

IP No: 1 120

Receipt No: Receipt_1120_3

Amount: 10000.00 (RUPEES TEN THOUSAND ONLy)

Payment Type: Cash

Received By: Muthulakshmi

Received At: 29/02/2024 t9:02


Authorized Signature
LAK$n"ltulI $- L. ii?ll"f iY C:r..:T'tiiH
lVo.S, Cl-'|i,.,:i";" ' l, ,
.-l irtilET
T'"[. [d, ;]'r.R
l(ARAtt{r.jLt - 0:r t01
nt https://mocdoc.inlstocks/print/bilUlakshmi-fertility-centre/location..
Krishnaa Phdrmacy
#S,Chtxch2nd St, TT Nagar, Karaikudi--630001
Phone:98943 31474
GSTIN: 33 ANILJ2T 3 6CIZN

Bill No: PHARM2324-39307


Consultant: Dr. PAKKIALAKSHMI M.B.B.S, M.D(OG).,
Datet 2710212024 07:78
DNB(OG)
Name ID Age Gender Mobile
Mrs. S.M.Sharmee S.Sudharsan LFC-9235 38 years F 9894823566
Payment Type: AgainstlP Payment Details:

SNo Name Expiry Qty Rate GST Total

l. EASY FD( MEDIUM 3Ut2/2025 I 47.00 12.00 47.00


2. EASY GLIDE SKIN BLADE 30/11/2028 2 39.00 12.00 78.00
IV SET.JAYAM 31/03/2026 I 190.00 12.00 190.00
4. UNDERPAD 8 42.50 18.00 340.00
5. PIONEERGLOVES M 20 12.20 12.00 244.00
6. 14 SIZE CAI}MTER FOLLICE SIZB 14 3110112027 1 137.00 12.00 137.00
7. URO BAG 3t/0812028 I 316.00 5.00 316.00
8. PANTAKIND IV 30/tt/2025 6 56.50 12.00 339.00
9. METROGYLIVFLUID 3t/08/2026 6 23.52 12.00 t4t.t2
10. DIHARD 3l/031202s 2 25.00 12.00 50.00
11. OPTIKET INJ 30/061202s 2 32.00 12.00 64.00
12. TEXAKIND-INJ 3t/10/202s 2 54.84 5.00 109.68
13. TRAMASURE IOOMG- INJ 30/09/202s 1 6.60 12.00 6.s9
14. PIIENERGAN 30/09/2026 1 14.80 12.00 14.80
15. EMESET-INJ 30/tU2026 6 13.35 12.00 80.10
16. AX-sOO INJ 3011U2025 6 r2r.00 0.00 726.00
t7. PIPTACLASS-4.s GM-INJ 3U07/2025 6 447.30 t2.00 2683.80
18. FEVASTIN -IV- 1 OOML-INJ 30/09/202s 6 467.00 12.00 2802.00
19. STERILE WAIER 1OML 3l/07/2026 2 2.89 12,00 5.78
20. RL sOOML 3t/1012026 5 63.27 12.00 316.35
2t. 1OO MLNS 3t/1212026 t2 21.99 12.00 263.88
22. DNS sOOML 3t/1012026 J 42.80 12.00 128.40
23. EP 5OOML 3010512025 J 191.00 12.00 573.00
24. ACECLOFISCH-SP-TAB 3t/10/2025 t4 8.90 12.00 124.60
25. METROGYL 4OOMG-TABLET 30/tt/2027 t4 1.70 12.00 23.83
26. RABERAS D 3U07/2024 t4 7.00 12.00 98.00
27. CEFFI.IX LB TABLET 3Ut0/2025 t4 13.90 12.00 194.60
28. CREMAFFIN 225ML 30/tt/202s I 280.86 12.00 280.86
29. D3 MUST FORTE -DROPS 3t/031202s I 90.53 12.00 90.53
30. WOKADINE POWDER 3t/1012026 I 96.00 12.00 96.00
31. GAVLON SANITZER-IOOML 30/11/2025 I 75.00 18.00 75.00
)2. DIS.NEEDLE 26 30/0612028 1 2.00 12.00 2.00
J3. LACTARE 3U08t2026 10 9.72 12.00 97.20
34. LACTA\MAYS 30109/2025 1 330.00 t2.00 330.00
35. BROMONTLC TABLET 31108/202s l0 9.s0 12.00 95.00
36. REVERTO L 30/11/202s 4 18,90 12.00 75.60
37. EMARALD 3ML SYRINGE 30/tt/2028 16 9.50 12.00 152.00
38. EMARALD 5ML SYR 3U07/2028 J 11.00 12.00 33.00
nt https://mocdoc. inlstocks/print/bilVlakshmi-fertility- centre/lo c ation. .

SNo Name Expiry aty Rate GST Total

41. BABY WIPES-l2 08/04/2024 I 85.00 18.00 85.00

42. NANPRO 1 805.00 18.00 805.00

Total 12887.72
Round Off 0.28
AmountTaxable 11550.14 GST 1336.98 CGST 668.49
Amount Receivable 12888.00
SGST 668.49
Amount (in words): RUPEES TWELVE THOUSAND EIGHT
Amount Received 12888.00
HUNDRED AND EIGHTY-EIGHT ONLY

PREPARED BY: Aruna

C ENTRE
LAKSHill I FERTII-ITY
N;5, ciunct-l ?'nd STREET
T.T, I.JAG;\R
KARAII(utll - 630 00L
int https://mocdoc.irVstocks/print/bilVlakshmi-fertility-centre/location.
Krishnaa Phdrmacy
#S,Church 2nd St, TT Nagar, Karaikudi--630001
Phone:98943 3147 4
GSTIN: 33AAIHJ2736CZN

Bill No: P}IARM2324 -39435


Consultant: Dr. PAKKIALAKSHMI M.B.B.S, M.D(OG).,
Date;27/02/2024 18:10
DNB(OG)
Name ID Age Gender Mobile
Mrs. S.M.Sharmee S.Sudharsan LFC-9235 38 years F 9894823566
Payment Type: AgainstlP Payment Details:

SNo Name Expiry Qty Rate GST Total

1. DY BRE AB CORSET:L 3t/07/2028 I 880.00 5.00 880.00

AmountTaxable 838.10 GST 41.90 CGST 20.95 SGST 20.95 AmountReceivatrle 880.00
Amount (in words): RUPEES EIGHT HUNDRED AND EIGHTY ONLY Amount Received 880.00

PREPARED BY: Dhanalakshmi


(* nt https://mocdoc.inlstocks/print/bilUlakshmi-fertility-centre/location.
Krishnaa Phdrmacy
#5,Church 2nd St, TT Nagar, Karaikudi--630001
Phone:98943 3147 4
GSTIN: 33AAIH.I2736CIZN

Bill No: PHARM2324 -39 4 49

Consultant: Dr. PAKKIALAKSHMI M.B.B.S, M.D(OG).,


Date:27/02/202419:08
DNB(OG)
Name ID Age Gender Mobile
Mrs. S.M.Sharmee S.Sudharsan LFC-9235 38 years F 9894823s66

Payment Type: AgainstlP Pavment Details:

SNo Name Expiry aty Rate GST Total

1. PRE-OPERATIVE KIT 1 262.s0 5.00 262.s0


2. DR GOWN 2 362.50 5.00 725.00
3. LrNTNrL C-MAI (GY30s7) 3U07/2026 I 2s9.62 12.00 2s9.62
4. I.]NDERPAD I 42.s0 18.00 42.50
5. }MMANAPKIN I 140.00 0.00 140.00
6. STERZONE ST 91 30/tU2026 I 3 15.00 12.00 315.00
7. SURGICARE 6.5 GLOVES 3t/10/2028 2 88.00 12.00 176.00
8. SURGICARE 7 GLOVES 3t/0812028 J 80.00 12.00 240.00
9. SURGICARE NEOPRINE-7 t0/1012025 1 165.00 t2.00 165.00
10. PIONEERGLOVES M 22 t2.20 12.00 268.40
11. SPIRIT4OOML 02/021202s 1 20s.00 12.00 205.00
12. BETADINE SOL 10% IOOML 30/tU202s 1 r07.52 12.00 107.s2
13. NEOFLON 24G 30/0912026 1 345.00 t2.00 34s.00
14. EASYFD(MEDIUM 31/121202s 1 47.00 12.00 47.00
15. SPINALNEEDLE 25G 31/1012028 1 238.50 12.00 238.50
16. BLADE-22 0t/0112028 1 5.50 12.00 5.50
17. NEEDLE 18 STZE 09/0912027 I 2.s0 12.00 2.50
18. LOXJELLY 2%3OG}id 3t/081202s 1 37.95 12.00 37.9s
19. SUCTIONTLIBE 3U1012028 I 532.00 12.00 532.00
20. RL 5OOML 3111012026 J 63.27 12.00 189.81
21. DNS 5OOML 3111012026 I 42.80 12.00 42.80
22. EMARALD 3ML SYRINGE 3011112028 4 9.s0 12.00 38.00
23. EMARALD 5ML SYR 31107/2028 5 11.00 t2.00 55.00
24. EMARALD IOML SYR 3Ut0/2028 I 18.50 12.00 18.50
25. MISOGYN2OOMG 3010912025 2 21.25 12.00 42.49
26. NEOMOL-250 SUP 31101/2026 4 19.78 12.00 79.12
27. PLAIN SFIEET D3OI 3110812026 I t23.00 12.00 123.00
28. MUCUS EXTRACTOR 3010912028 1 86.00 12.00 86.00
29. INF FEED TUBE-6 SIZ 0310312028 I 61.00 12.00 61.00
30. OT SELECT-sO 311031202s 4 25.90 12.00 103.60
31. CARD CLAMP 3U0U2026 I 18.30 12.00 18.30
32. STERILEWATER IOML 3110712026 2 2.89 12.00 5.78
OBKIT I8OCM2347 281021202s I 649.00 12.00 649.00
3+. l QUALGUT QNW 4259 1310812026 I 151 .00 12.00 151.00
35. APRONDISPOSABLE 30107/2026 2. 40.00 18.00 80.00
36. HAND CONTROLPENCIL I 786.00 12.00 786.00
37. MEDI CAP(BLIF) 30104/202s l5 10.00 s.00 150.00
38. DISPOSABLE MASK 15 4.00 5.00 60.00
int
SNo Name Expiry Qty GST Total

41. EVATOCIN-INJ 3U08/2025 4 19.94 12.00 79.76


42. KENADION-I-INJ 3t/10/2025 1 17.13 t2.00 t7.13
43. ROSCLLIN INJ 5OOMG 3y0812025 1 1s.95 12.00 15.95
44. CARITEC-INJ 3U05/2026 I 483.00 12.00 483.00

Total7520.23
Round Off (10.23
AmountTaxable 6795.19 GST 725.04 CGST 362.52
Amount Receivable 7520.00
SGST 362.52
Amount (in words): RUPEES SEVEN THOUSAND FM HUNDRED
Amount Received 7520.00
AND TWENTY ONLY

PREPARED BY: Dhanalakshmi

'$HviqffifilsIss
630 001 -
rnnnirupl
-
( at https://mocdoc.in/stocks/print/bilVlakshmi-fertility-centre/location.
Krishnaa Phdrmacy
#5,Church 2nd St, TT Nagar, Karaikudi--630001
Phone:989 4331474
GSTIN: 33AAIHJ2736CIZN

Bill No: PHARM2324 -39492


Consultant : Dr. PAKKIALAKSHMI M.B.B. S, M.D(OG).,
Datet 2S/0212024 10:20
DNB(oG)
Name ID Age Gender Mobile
Mrs. S.M.Sharmee S.Sudharsan LFC-923s 38 years F 9894823566
Payment Type: AgainstlP Pavment Details:

SNo Name Expiry Qty Rate GST Total

I. LABECOR IOOMG TAB 3r/08/2025 10 16.42 12.00 t64.ts


Total 164.15
Round Off (-)0.15
AmountTaxable 146.57 GST 17.58 CGST 8.79 SGST 8.79 Amount Receivable 164.00
Amount (in words): RUPEES ONE HUNDRED AND SIXTY-FOUR
Amount Received 164.00
ONLY

PREPARED BY: Dhanalakshmi

'$r?:3riliffiff#s \
KARAIKU}I'
LJt _ lrttps://mocdoc.inlstocks/print/bilVlakshmi-fertility-centre/location.
Krishnaa Phdrmacy
#S,Church 2nd St, TT Nagar, Karaikudi-630001
Phone:98943 31474
GSTIN: 33AAIHJ2736CZN

Bill No: PHARM2324-39496


Consultant: Dr. PAKKIALAKSHMI M.B.B. S, M.D(OG).,
Datet 2S/0212024 10:36
DNB(OG)
Name ID Age Gender Mobile
Mrs. S.M.Sharmee S.Sudharsan LFC-923s 38 years F 9894823566

Payment Type: AgainstlP Payment Details:

SNo Name Expiry ary Rate GST Total

I. SUP.DULCOFLEX 3010912025 2 40.71 12.00 81.42

Total 81.42
Round Off (-)0.42
Amount Taxable 72.70 GST 8.72 CGST 4.36 SGST 4.36 AmountReceivable 81.00
Amount (in words): RIIPEES EIGHTY-ONE ONLY Amount Received 81.00

PREPARED BY: Dhanalakshmi

LAKSHFJII FE$TTILITY CENTRE


NO.5, CHURCH zNd STREET
T.T. i'i,:.{:.AR
KARAilf.LJilr - 630 00L
'int httos://mocdoc irVstocks/print/bilVlakshmi-fertility-centre/location...
.

Krishnaa Phdrmacy
#S,Church 2nd St, TT Nagar, Karaikudi-630001
Phone:9894331474
GSTIN: 33 AAIlll27 3 6CIZN

Bill No: PI{ARM2324 -39641


Consultant: Dr. PAKKIALAKSHMI M.B.B. S, M.D(OG).,
DNB(OC) Datet 29/02/2024 07:13

Name ID Age Gender Mobile


Mrs. S.M.Sharmee S.Sudharsan LFC-9235 38 years F 9894823s66
Payment Type: AgainstlP Payment Details:

SNo Name Expiry Qty Rate GST Total


1. ROSCLLIN INJ 5OOMG 3110812025 1 15.95 12.00 15.95
2. MIKASTAR-IOOMG INJ 06106/2025 I 35.04 5.00 35.04
3. EMARALD 3ML SYRINGE 30/tt/2028 J 9.s0 12.00 28.50
4. EMARALD 5ML SYR 31107 /2028 I 11.00 12.00 11.00
5. STERILE WAIER 1OML 3t/07t2026 1 2.89 12.00 2.89

Total 93.38
Round Off (-)0.38
AmountTaxable 85.48 GST 7.90 CGST 3.95 SGST 3.95 AmountReceivable 93.00
Amount (in words): RIIPEES NINETY-THREE ONLY Amount Received 93.00

PREPARED BY: Aruna

H[::y-\[,Ht]lfJS#s-
rnnnir<uol - 630
oo'----
.
Pi* https://mocdoc.in/stocks/print/bill/lakshmi-ferlility-centre/[ocation..
Krishnaa PhdrmacY
#5,Church 2nd St, TT Nagar, Karaikudi--630001
Phone:989433147 4
GSTIN : 33AAIHJ2736CIZN

Bill No: PIIARM2324-39647


Consultant: Dr. PAKKIALAKSHMI M.B'B. S, M.D(OG)', Datez 2910212024 01:27
DNB(OG)
ID Age Gender Mobile
Name
LFC-9235 38 years F 9894823s66
Mrs. S.M.Sharmee S.Sudharsan
Payment Type: AgainstlP Payment Details:

Expiry Qty Rate GST Total


SNo Name

0s105/2028 1 46.00 12.00 46.00


1. SV SET
3U051202s 22.90 12.00 22.90
2. OT SELECTPLUS 50 1

3010612028 I 2.00 t2.00 2.00


DIS.NEEDLE 26'
Total 70.90
Round Off 0.10

63.30 GST 7.60 CGST 3'80 SGST 3'80 Amount Receivable 71.00
AmountTaxable
Amount Received 71.00
Amount (in words): RUPEES SEVENTY-ONE ONLY

PREPARED BY: Aruna

*5?l$\F"11llsIlJff
630 oOx
x.nnnir'tlul-
'int
-https://mocdoc.in/stocks/print/bilVlakshmi-fertility-centre/location...
Krishnaa Phdrmacy
#5,Church 2nd St, TT Nagar, Karaikudi--630001
Phone:98943 3147 4
GSTIN: 33AAIHJ2736CIZN

Bill No: PHARM2324 -39663


Consultant: Dr. PAKKIALAKSHMI M.B.B.S, M.D(OG).,
Date:29/02/2024 10:46
DNB(oG)
Name ID Age Gender Mobile
Mrs. S.M.Sharmee S.Sudharsan LFC-9235 38 years F 9894823566
Payment Type: AgainstlP Payment Details:

SNo Name Expiry Qty Rate GST Total

1. SIIELCAL SYP 30106/202s 1 137.20 12.00 137.20

Total 137.20
Round Off (-)0.20
Amount Taxable 122.50 cST 14.70 CGST 7.35 SGST 7.35 Amount Receivable 137.00
Amount (in words): RUPEES ONE HUNDRED AND THIRTY-SEVEN
Amount Received 137.00
ONLY

PREPARED BY: Ramjan

LSKlHIrlt FERTTLITY CENTRE


No.S, CHt..irIi;l-, ?".t
" STRi;i:
l:'4lAR
ii., .; , -. . ;.]C 001
_ -https://mocdoc.in/stocks/print/returnbill/lakshmi-fertility-centre/lo.
a*r, Krishnaa Pharmacy
#5,Church 2nd St, TT Nagar, Karaikudi--630001
Phone:98943 3141 4
GSTIN: 33AAIHJ2736CIZN

Return Bill
Bill No: RETPHARM2324-387
Consultant: Dr. PAKKIAIAKSHMI M.B.B.S, M.D(OG)., DNB(OG) Datez 29/02/2024 12:17
NAME AGE GENDER MOBILE
MRS. S.M.SIIARMEE
LFC-9235 38 YEARS F 9894823566
S.SUDHARSAN
PAYMENT TYPE: AGAINSTIP PAYMENT DETAILS:
S.No Name Expiry Qty GST(%) Total
I RL 5OOML 31/10/2026 I 12.00 63.27
2 DNS 5OOML 3U10t2026 I 12.00 42.80
J EP 5OOML 30/05/2025 I 12.00 191.00

Total 297.07
Round Off (-)0.07
AmountTaxable 265.25 GST 31.82 AmountPayable 297,00
Amount (in words): RUeEES Two HUNDRED AND NrNEt.y_sEVEN oNLy
Amount Paid 297.00
PREPARED BY: Dhanalakshmi

LAKSr{ I i I Fii.i:lTlt"lTY * Hl';T${};


No.$, Ci-tl ji,.'.:
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httos://mocdoc.irVstocks/print,fuilVlakshmiferlility-centre/location..
Prin.
Krishnaa PhdrmacY
#5,Church 2nd St, TT Nagar, Karaikudi--630001
Phone:98943 3147 4
GSTIN: 33AAIHJ2736CIZN

Bill No: P}IARM2324-397 04

M'B'B'S' M'D(OG)'' Date;2910212024 l3:01


Consultant: Dr. PAKKIALAKSHMI
DNB(OG) Mobile
Age Gender
Name
ID
F 9894823566
LFC-9235 38 years
Mrs. S.M.Sharmee S'Sudharsan
Payment Details:
Payment Type: AgainstlP
Rate GST Total
Expiry Qty
SNo Name
18.50 12.00 37.00
3U1012028 2
1. EMARALD 1OML SYR 12.00 19.00
3011r12028 2 9.50
2. EMARALD 3ML SYRINGE
Amount Receivable 56.00
Amount Taxable 50.00 GST 6.00 CGST 3.OO SGST 3.OO
56.00
Amount Received
ONLY
Amount (in words): RUPEES FIFTY-SIX

PREPARED BY: Dhanalakshmi

No.S, CHU$?CH 2nd STREET


I.T" hJAGAR
l/..Ai-lAlit"L.iDl - 630 00L

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