|
[Remarks]
|
|
Gross Amount
|
[gross]
|
|
Discount
|
[Discount]
|
|
[Billother] |
[BillOtherAmt]
|
|
Net Amount
|
[ActNet Amount] |
|
GST
|
[GSTAmt]
|
|
CGST
|
[CGST]
|
|
SGST
|
[SGST]
|
|
CESS
|
[CESS]
|
|
Tax Amount |
[TaxAmt] |
|
Total Amount
|
[Net Amount] |
|
Non insured Amount
|
[noninsamt]
|
|
Less Advance
|
[Adavnce Amount]
|
|
Patient Payable
|
[Payable Amount]
|
|
Claimed Amount
|
[ClaimedAmount]
|
|
|
In Words:[rupees]
|
|
Claimed Amount In Words:[Crupees]
|
| Billed by |
Checked By |
Dispersed By |
|
[UserName]
[Outlet]
[Counter]
Printed Date : [PrintDate]
|
|
|
|
Terms and condition : Return of medicines
|
|