[Hospital Name]

[HospitalAddress]
 

[RefundType]
[PatientName] Patient ID [Patient Id]
[Age] Refund # [Refund No]
[Address] Refund Date [Refund Date]
[docname] Bill # [Bill No]
[item List]
 
Gross Amount [groamt]
Discount [discamt]
Net Amount [netamt]
Tax Amount [TotalTaxAmount]
CGST [Cgst]
SGST [Sgst]
Total Amount [TotalAmount]
Co-payment/Deduct Amount [copayamt]
Non-Insured Amount [noninsamt]
Return To Patient [Total]
[rupees]
Claimed Amount [claimamt]
Counter :[counter] Cashier User :[user]