[Hospital Name]

                This is to certify that [PatientName]  Patient ID [PatNo] IP No [IpNo]
                 S/o/W/o/D/o/F/o Mr.[Relative] 
                 is suffering from [AdmnReason] 
                 is required [SurgName] to be done/performed and the approximate stay in 
                 the hospital will be [StayDuration] days. The above mentioned patient is adviced to be/ has 
                 been admitted on [Admndate].


                Note:The above mentioned statement is based on prelimenery diagnosis.

              

                Signature of the Treating Doctor
               
                The above mentioned patient has opted for PR / SBR / NSB accomodation. The approxinate
                expence for the above mentioned treatment would be about Rs.[AssessmentAmount] (Rupees
                [AmountWords] only).

                You are requested to Kindly issue the authorization letter at the earliest.

                In case of any further clarification or information donot hesitate to ring the under
                signed.