[Hospital Name]

[HospitalAddress]

[VOUCHERHEAD]
Patient Name [PatientName] Patient Number [PatientNumber]
Address [Address] IP No [ipno]
Bill Date [BillDate]
Age/Gender [AgeGender] Bill No [Billno]
PAN No [PANCARD] Doctor [doctor]
Mobile No [contactno] Receipt No [Receiptno]

Sl# Payment Mode Card/Cheq No./Ref/No Exp./Cheq./Transfer Date Card Name Amount
[s1] [PaymentMode1] [No1] [Date1] [CardNM1] [Amount1]
[s2] [PaymentMode2] [No2] [Date2] [CardNM2] [Amount2]
[s3] [PaymentMode3] [No3] [Date3] [CardNM3] [Amount3]
[s4] [PaymentMode4] [No4] [Date4] [CardNM4] [Amount4]
Discount given : [Discount]
[Cash In Words] Total
[TotalAmount]
Remarks: [Remarks]
Prepared By Counter

[user]

[CounterName]