[Hospital Name]

[HospitalAddress]

INPATIENT BILL SUMMARY

Patient Name	[PatientName]	Patient Number	[PatientNumber]
Address	[Address]	Bill No	[Dischargeno]
Bill Type	[BillType]
Age/Gender	[AgeGender]	Bill Date	[BillDate]
PAN No	[PANCARD]	IP No	[ipno]
Mobile No	[contactno]	Doctor	[doctor]
Admission Date	[AdmissionDate]	Department	[dep]
Discharge Date	[DisBillDate]	Bed No	[bdno]
Customer	[Customer]

[Item List]

		   
                [Remarks]
			

Gross Total	[grosstot]
Pharmacy Returns	[PharmReturn]
Other Returns	[OtherReturn]
Discount	[discount]
Net Amount	[TotalAmount]
Medicine Return	Pharmacy Return	[salesret]
Co-Payment Amount	[copay]
Noninsured Amount	[noninsured]
Tax Amount	[taxamount]
CESS	[CESS]
Net Amount(Include Tax)	[netamountwithtax]
Advance	[advance]
Claimed Amount	[claim]
[SettlementCap]	[Settlement]
Discount against Receipt	[RecDiscount]

CGST	[CGST]
SGST	[SGST]
Total Amount	[ptpay]
[Cash In Words]

Prepared By	Counter	Checked By
[user]	[CounterName]	[user]