[Hospital Name] [HospitalAddress]
CREDIT REFUND

Patient Name	[PatientName]	Patient ID	[Patient ID]
Address	[Address]	Age/Gender	[Age]
PAN No	[PAN]	MobileNo	[Mobile]
Receipt No	[rcno]	Refund Date	[rfdate]
Customer	[Customer]

[Item List]

In Words :[rupees]

[Remarks]

Prepared by

Counter

[user]

[PrintDate]

[counter]

For [Hospital]
Authorized Signatory