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Charges Head Description Rate Qty Disc Amount
Doctor Charges
22-08-2015 Doctor Visit Charges Dr Gautam Sarkar 1,350.00 0.00 1,350.00
22-08-2015 ICU Team Fees Hospital Team 200.00 0.00 200.00
Sub Total: 1, 550.00
Registration
22-08-2015 Documents And Diet 1,075.00 0.00 1,075.00
Management
Sub Total: 1,075.00 ICU Charges
22-08-2015 ICU BED CHARGES 330A 3,200.00 0.00 3,200.00
(22-08-201515:15 to 26-08-201512:00)
SubTotal: 3,200.00
Diagnostics
22-08-2015 Lab Tests Charges Serology Profile(IPD) 1,575.00 0.00 1,575.00
22-08-2015 Lab Tests Charges CREATININE 320.00 0.00 320.00
22-08-2015 Lab Tests Charges Potassium(K) 380.00 0.00 380.00
22-08-2015 Lab Tests Charges Sodium(Na) 380.00 0.00 380.00
22-08-2015 Lab Tests Charges UREA 320.00 0.00 320.00
22-08-2015 Lab Tests Charges ABG - Blood Gas Analysis 1,250.00 0.00 1,250.00
22-08-2015 Lab Tests Charges HB TC DC 230.00 0.00 230.00
22-08-2015 Lab Tests Charges Calcium 280.00 0.00 280.00
22-08-2015 Lab Tests Charges Liver Function Test 1,200.00 0.00 1,200.00
22-08-2015 Lab Tests Charges AMYLASE 610.00 0.00 610.00
22-08-2015 Lab Tests Charges LIPASE 675.00 0.00 675.00
22-08-2015 Lab Tests Charges Urine RE 200.00 0.00 200.00
22-08-2015 Lab Tests Charges (Report 1,000.00 0.00 1,000.00
After 3 Culture And Sensitivity(MIC)
Days]
23-08-2015 Lab Tests Charges Potassium(K) 380.00 0.00 380.00
23-08-2015 Lab Tests Charges UREA 320.00 0.00 320.00
23-08-2015 Lab Tests Charges CREATININE 320.00 0.00 320.00
23-08-2015 Lab Tests Charges Sodium(Na) 380.00 0.00 380.00
23-08-2015 Lab Tests Charges Tc Dc 190.00 0.00 190.00
23-08-2015 Radiology Tests Charges Usg Whole Abdomen 2,250.00 0.00 2,250.00
Sub Total: 12,260.00
Other Charges
Sub Total: 55.00
Medicines & Consumables22-08-2015 Pharmacy Sales 893.47 1 0.00 893.47
22-08-2015 Pharmacy Sales 996.72 0.00 996.72
22-08-2015 Pharmacy Sales 2,224.26 0.00 2,224.26
Pharmacy sales bill
(No. SB282252)
Pharmacy sales bill
(No. SB282253)
Pharmacy sales bill
(No. SB282323)
Final Bill
Name:
Age/Sex:
Address:
Department:
Doctor :
Bed Type:
Refer red By:
Pravat Behura
24 Y M
Cuttack, Odisha
GENERAL MEDICINE & CARDIOLOGY
Dr Gautam Sarkar
ICU8
Hospital Generated
Bill No:
Bill Date:
MR No:
Visit I D:
AdmissionDate:
Discharge Date:
Rate Plan:
BLA23196
26-08-2015
MR076958
IP020983
22-08-2015 15:22
26-08-2015 15:30
GENERAL
Services &
Pr ocedures22-08-2015
Services And Procedure 450.00 0.00 450.00
ChargesInitial Managemtcharge
Sub Total: 450.00
Service Charges
Sub Total: 4,114.45
Report delivery time :7.00 p.m To 8.30 p.m (Report to be collected within one month)
Booking inadvance does not ensure any bed category at the time of admission Page 1 of 2
Advance booking amount not refundable
