MEDIWARE HEALTHCARE HOSPITAL

Plot No 16 A, , It Park, Csez, Kakkanad , Ernakulam, Kerala 680037, 0415689

Inpatient Invoice Detailed
Mr.Linju/25 Y/M Patient Number 0001225070
Test Bill No 000043
Bill Type Cash
Bill Date 17/01/2017
Admission Date : 05/01/2017 04:04:16 PM IP NO 0000000024
Discharge Date : 17/01/2017 11:12:02 AM Doctor Dr.Arvind
Patient Type : GENERAL Department General Services
Bed No 104/1
Description Date Qty Rate Gross Amt Discount Net Amt
LUXURY TAX
* 2-Bed-104/1 14/01/2017 1 10.00 10.00 0.00 10.00
* 2-Bed-104/1 10/01/2017 4 10.00 40.00 0.00 40.00
* 2-Bed-104/1 14/01/2017 1 10.00 10.00 0.00 10.00
* 2-Bed-104/1 06/01/2017 1 10.00 10.00 0.00 10.00
* 2-Bed-104/1 13/01/2017 4 10.00 40.00 0.00 40.00
* 2-Bed-104/1 17/01/2017 3 10.00 30.00 0.00 30.00
VISITING CHARGE
* 2-Bed-104/1 06/01/2017 1 10.00 10.00 0.00 10.00
* 2-Bed-104/1 10/01/2017 4 10.00 40.00 0.00 40.00
* 2-Bed-104/1 13/01/2017 4 10.00 40.00 0.00 40.00
* 2-Bed-104/1 17/01/2017 3 10.00 30.00 0.00 30.00
* 2-Bed-104/1 14/01/2017 1 10.00 10.00 0.00 10.00
* 2-Bed-104/1 14/01/2017 1 10.00 10.00 0.00 10.00
RESERVATION
* 2-Bed-104/1 10/01/2017 4 10.00 40.00 0.00 40.00
* 2-Bed-104/1 14/01/2017 1 10.00 10.00 0.00 10.00
* 2-Bed-104/1 17/01/2017 3 10.00 30.00 0.00 30.00
* 2-Bed-104/1 13/01/2017 4 10.00 40.00 0.00 40.00
* 2-Bed-104/1 14/01/2017 1 10.00 10.00 0.00 10.00
* 2-Bed-104/1 06/01/2017 1 10.00 10.00 0.00 10.00
BILLCHARGE
* 2-Bed-104/1 13/01/2017 4 55.00 220.00 0.00 220.00
* 2-Bed-104/1 06/01/2017 1 55.00 55.00 0.00 55.00
* 2-Bed-104/1 14/01/2017 1 55.00 55.00 0.00 55.00
* 2-Bed-104/1 17/01/2017 3 55.00 165.00 0.00 165.00
* 2-Bed-104/1 14/01/2017 1 55.00 55.00 0.00 55.00
* 2-Bed-104/1 10/01/2017 4 55.00 220.00 0.00 220.00
ROOM CHARGES
* 2-Bed-104/1 17/01/2017 3 111.00 333.00 166.50 166.50
* 2-Bed-104/1 14/01/2017 1 111.00 111.00 55.50 55.50
* 2-Bed-104/1 06/01/2017 1 111.00 111.00 55.50 55.50
* 2-Bed-104/1 14/01/2017 1 111.00 111.00 55.50 55.50
* 2-Bed-104/1 13/01/2017 4 111.00 444.00 222.00 222.00
* 2-Bed-104/1 10/01/2017 4 111.00 444.00 222.00 222.00
SURGERY -1 STAGE POSTERIOR CORRECTION
A0023 17/01/2017 1 390.00 780.00 0.00 780.00
Room Charges 17/01/2017 1 5,000.00 5,000.00 0.00 5,000.00
1 St Hr Blood Glucose 17/01/2017 1 270.00 540.00 0.00 540.00
Operation Charges 17/01/2017 1 3,000.00 3,000.00 0.00 3,000.00
Surgeon Fee 17/01/2017 1 3,000.00 3,000.00 0.00 3,000.00
Gross Total 15,064.00
Discount 777.00
Sales Return 0.00
Net Amount 14,287.00
Co-Payment Amount 0.00
Noninsured Amount 0.00
Patient Payable 14,287.00
Amount to be claimed 0.00
Patient Payable Fourteen Thousand Two Hundred and Eighty Seven
Claimed Amount Zero
* Non insured items
Cashier
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