[Hospital Name]

[HospitalAddress]
[Billtype]
                [PatientName]
              [Age]
              [Address]
              [contactno]		        
Patient No : [Patient Id] Doctor : [doctor]
       
Bill No : [Bill No]    
       
Bill Date : [Bill Date] Patient Type : [Ptype]
       
   
[item List]
Patient
Non insured Amount [noninsamt]
Patient Payable [Payable Amount]
Rupees : [rupees]
Net Amount
[Net Amount] 		Gross Amount :     [gross]

Discount :     [discount]
 Insurance /Corporate 
 
Printed Date :  [PrintDate] Signature & Stamp
[UserName]
 [Cashier] 		 
Outlet  Name: [Counter]