[Hospital Name]
[HospitalAddress]
|
|
|
[PATTYPE]
|
| [Cancel] |
|
[PatientName]
[Age]
|
|
[Address1]
|
|
[Address2]
|
|
[contactno]
|
|
[Customer]
|
[customerName]
|
|
|
Patient No :
|
[Patient Id]
|
|
Bill No :
|
[Bill No]
|
|
Bill Date :
|
[Bill Date]
|
|
Doctor :
|
[Doctor]
|
|
Department :
|
[Department]
|
|
Consulting Room :
|
[Consultingroom]
|
|
|
|
|
|
[Token Number]: [Bookingtm]
|
[Token] [toke2]
|
Amount In Rupees
|
|
|
|
[item List]
|
|
|
|
Patient
|
|
[copayment]
|
[copaymentamt]
|
|
[noninsured]
|
[noninsuredamt]
|
|
Patient Payable
|
[Total]
|
|
[rupees]
|
|
Net Amount
[NetTotal]
|
|
Gross Amount
|
[GossTotal]
|
|
Discount
|
[Disc]
|
|
Insurance / Corporate
Claimed Amount
|
[claimAmount]
|
|
[claimWords]
|
|
|
|
|
Date of Next Renewal : [RenewDate]
|
Cashier
|
|
|
|
Counter :[counter]
|
User :[user]
|