Approximate Expenses from [AdmDate] to [UptoDate]

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]

[Item List]

	Gross	[gross]
	Discount	[discount]
	Refund Amount	[Medicinereturn]
	Advance	[adavnce]
	Tax Amount	[TaxAmount]
	Patient payable	[Balance]
	Amount to be claimed	[claim]
Amount : [rupees]
Claimed Amount : [claimamt]
Remarks : [Remarks]
Prepared By :[user] Printed Date :[PrintDate]		Cashier