[Hospital Name]

[HospitalAddress]

Return Voucher
Cash Refund
[Drug Lic No]
[Tin No]
[PatientName]
[Age]
[Address]
[contactno]
Patient No : [Patient Id] Doctor : [doctor]
Return No : [Bill No] Department : [department]
Date : [Bill Date] Patient Type : [Ptype]
[item List]
Patient
Non insured Amount [noninsamt]
Patient Refundable [Payable Amount]
In Words :[rupees]
Net Amount
[Net Amount] 		Gross Amount :     [gross]
Vat Amount     :     [Vat]
Cess Amount   :     [Cess]
Discount           :     [Discount]
Insurance /Corporate
 
Printed Date : [PrintDate]   Signature & Stamp
[UserName]
 [Cashier]