[Counter] - [Billtype]

[DuplicateBill]

Patient ID	[Patient Id]	Bill #	[Bill No]
Patient Name	[PatientName]	Bill Date	[Bill Date]
Age & Gender	[Age]	Patient Type	[Ptype]
Address	[Address]	Doctor	Dr. [doctor]
Contact No.	[contactno]	Department	[department]
Bed #	[bed]	Ward #	[Ward]
[Customer]	[CustomerName]
[lblReferenceHos]	[RefHosp]	[lblReferenceDr]	[RefDr]
[lblcusvatregno]	[cusvatregno]

[item List]

Gross Amount	[gross]
Discount	[discount]
Net Amount	[Net Amount]
[TaxAmountlbl]	[TotalTax]
[cgst]	[cgsttot]
[sgst]	[sgsttot]
Non insured Amount	[noninsamt]
Co-Pay/Deduct Amount	[CopDeduct]
Less Advance	[Adavnce Amount]
Patient Payable	[Payable Amount]
Settled Amount	[Settled Amount]
Pending Amount	[Pending Amount]
Claimed Amount	[claimedamount]

Patient Payable : [rupees]

Claimed Amount : [Crupees]

Printed Date : [PrintDate]

Signature & Stamp

Cashier : [User]