[Hospital Name]

[HospitalAddress]

[PATTYPE] [BillStatus]
[PatientName]  [Age]
[Address1]
[Address2]
[Customer] [customerName]
Patient No : [Patient Id]
Bill No : [Bill No]
Bill Date : [Bill Date]
Doctor : [Doctor]
Department : [Department]
Amount In Rupees
[item List]
Patient
[copayment] [copaymentamt]
[noninsured] [noninsuredamt]
Patient Payable [Total]
[rupees]
Net Amount
[NetTotal]
Gross Amount [GossTotal]
Discount [Disc]
Insurance / Corporate

Claimed Amount


[claimAmount]
[claimWords]
Cashier
Counter :[counter] User :[user]