[Hospital Name]

[HospitalAddr1]
[HospitalAddr2]
[lblvatregno] [vatregno]

[Billtype]
[DuplicateBill]
Patient ID [Patient Id] Bill # [Bill No]
Patient Name [PatientName] Bill Date [Bill Date]
Address [Address]
[contactno]		 Patient Type [Ptype]
Bed # [bed] Doctor Dr. [doctor]
Ward # [Ward] Department [department]
Ward # [Ward] Bed # [bed]
[lblReferenceHos] [RefHosp] [lblReferenceDr]  [RefDr]
[lblcusvatregno] [cusvatregno]
[item List]
Gross Amount [gross]
Discount [discount]
Net Amount [Net Amount]
[TaxAmountlbl] [TotalTax]
[cgst] [cgsttot]
[sgst] [sgsttot]
[cess] [cessamt]
Total Amount [TotalAmount]
Non insured Amount [noninsamt]
Co-Pay/Deduct Amount [CopDeduct]
Less Advance [Adavnce Amount]
Patient Payable [Payable Amount]
Settled Amount [Settled Amount]
Pending Amount [Pending Amount]
Claimed Amount [claimedamount]
Patient Payable : [rupees]
Claimed Amount : [Crupees]

Printed Date : [PrintDate]

Signature & Stamp

[UserName]

Cashier