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Receipt 1721708917

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444 views2 pages

Receipt 1721708917

Uploaded by

nettrohit1976
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Fortis Escorts Hospital

Jawahar Lal Nehru Marg, Malviya Nagar,Jaipur


- 302017 (Rajasthan) UPI SCAN
Tel: +91 NA, 0142547000 | Fax: NA & Pay
Emergency: 0141-2547009 | Ambulance: 0141-
2547009 GST
Email:contactus.jaipur@fortishealthcare.com | No:08AABCF3718N1ZE
Website: www.fortishealthcare.com

OUT PATIENT BILL


Primary
: Dr. Sandeepan Mukul
Name : Ms. Aishwarya Sharma Doctor
UHID : 12322782 Ref Doctor : Direct Walk in
Contact No. : 8460835028 Payor Name : NA
Age/Sex : 29 YEAR(S)/Female Payor Site
: NA
Episode No. : 93041/24/1102 Name
Bill Date : 2024-07-23 09:56:00 Discount
: NA
Print Date : 2024-07-23 09:56:00 Scheme
: 412 Rajni vihar hirapura 200bye Insurance : NA
Patient TPA : NA
pass road jaipur Jaipur 302021
Address
Rajasthan India CIN No : U93000DL2009PLC222166
Emp.Name : NA

BILL NUMBER BILL TYPE BILL DATE BILL AMOUNT


110224OPCS122361 CASH 2024-07-23 09:56:00 700.00

Accession HSN Service Contractual Net Gross


Sr No. Particulars Qty
No Code Amount Discount Amount
CONSULTATION-Sandeepan Mukul
1 999312 1 700.00 0.00 700.00
(PLASTIC SURGERY)
TOTAL AMOUNT 700.00 0.00 700.00
BILL AMOUNT 700.00
PAYOR SHARE 0.00
PATIENT SHARE 700.00
TOTAL
0.00
DISCR.DISCOUNT
PAID BY PATIENT 700.00
NET PATIENT PAYABLE 700.00
BILL ROUND OF
0.00
AMOUNT
Rupees in Words: Rupees Seven Hundred only
Payour details
Name: NA
Address: NA
GSTIN: NA
Prepared by Tejasvini Ramawat Cashier Manager
Note: None

Reciept Details
Sr No. Reciept No. Reciept Date. Amount Balance Amount Payment
1 1102/DP/2407/108418 2024-07-23 09:56:00 700.00 0.00 0.00

Regd.Office: A Unit of Fortis Hospitals Limited, Escorts Heart Institute and Research
Centre, Okhla Road, New Delhi - 110025 (India)
Tel: +91-11-26825000, Fax: +91-11-41628435, CIN: U93000DL2009PLC222166

Note:This is computerized generated invoice doesn't required signature.


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