Patient ID : [OPNo] IP.No. : [IpNo] Patient Name : [PatientName] Age/Sex : [Age] Address : [address] Admission Dt. : : [AdmDate] [address1] Up to Date : [UptoDate] [address2] Bed : [Bed] Doctor : [Doctor]

[item List]
[item List1]
	Gross	[gross]
	Discount	[discount]
	Medicine Return	[Medicinereturn]
	Advance	[adavnce]
	Balance	[Balance]
Amount in Rupees :	[rupees]
Remarks : [Remarks]
Prepared By :[user]	Counter :[counter]	Cashier