[Hospital Name]

[HospitalAddress]

IP DEPOSIT RECEIPT

Patient Name [PatientName]	Patient No	[Patient Id]
Age [Age]	Invoice No	[Advance No]
Address [Address]	Date	[Advance Date]
	IP No	[IPNo]
	Doctor	Dr [Doctor]
	Department	[Department]
Admitted Date :[Admitted Date]	Bed	[Bed]
	Ward	[Ward]

Amount in Rupees

[item List]

[rupees]

Total
[Total]

Recieved with thanks from [PatientName]

Remarks : [Remarks]

Prepared By :[user]

Counter :[counter]

Cashier