[Hospital Name]

[HospitalAddress]

Inpatient Invoice Summary
[PatientName] Patient Number [PatientNumber]
[Address] Bill No [Dischargeno]
Bill Type [BillType]
Bill Date [BillDate]
Admission Date : [AdmissionDate] IP NO [ipno]
Discharge Date : [DisBillDate] Doctor [doctor]
Patient Type : [ptype] Department [dep]
Bed No [bdno]
[table1]
Co-Payment Amount [copay]
Noninsured Amount [noninsured]
Advance [advance]
Patient Payable [ptpay]
[Cash In Words]		 Net Amount
[TotalAmount]
Gross Total [grosstot]
Discount [discount]
Sales Return [salesret]
Cashier
Counter : [CounterName]