Approximate In-patient Bill

Patient ID	:	[OPNo]	IP#	:	[IpNo]
Patient Name	:	[PatientName]	Age/Sex	:	[Age]
Address	:	[address]	Admission Date	:	[AdmDate]
		[address1]	Up to Date	:	[UptoDate]
		[address2]	Bed	:	[Bed]
Doctor	:	[Doctor]	Policy/Card #[colun2]	:	[PlolicyNo]
Policy [colun1]	:	[PolicyName]

[item List][cpt Code]

Discount :	[Deduction]	Gross	[gross]
Refund/Medicine Return :	[refund]	Less Deductions	[discount]
Total Deduction :	[totDeduction]	Net Amount	[netamount]
		Copayment	[copayment]
		Advance	[adavnce]
		Tax Amount	[TaxAmount]
		Patient payable	[Payable Amount]
		Amount to be Claimed	[claim]

Amount in Rupees :

[rupees]

Claimed Amount :

[claimamt]

Remarks : [Remarks]

Prepared By :[user]

Cashier