[Hospital Name]

[HospitalAddress]
[Billtype] [DuplicateBill]
Drug Lic No: [Drug Lic No]
Tin No: [Tin No]
[PatientName]   [Age]
[Address]
-
Patient No : [Patient Id] Token No: [Token]
Bed No          : [bed]
Doctor           : [doctor]
Bill No         : [Bill No] Department : [department]
Bill Date      : [Bill Date] Patient Type : [Ptype]
[item List]
Non insured Amount [noninsamt]
Less Advance [Adavnce Amount]
Patient Payable [Payable Amount]
In Words :  [rupees]
Cash [Cash]
Net Amount : [Net Amount] Gross Amount :     [gross]
Vat Amount     :     [Vat]
Cess Amount   :     [Cess]
Insurance /Corporate
Rupees : [Crupees]
 
Printed Date : [PrintDate] Signature & Stamp
[UserName]
 [Cashier]