<3 METRO pan HOSPITALS & HEART INSTITUTE ee Ie tt nf esas) SILL OF SUPPLY ( PRovisiceaL BILL ) 1.0.40 tn10/2023026574 ADMISSION sre /2024001617 {qAAFIZPUR, GURUKCL SIKANDRABAD, GAUTAM SUDH SAR, OFTAR B ‘PRADESH, INDIA OR. R.K. CHOUDEARY © Ten Oncelosy ee ee BED CATS. BED wo ROMESSSTON/DIGEAAGE oR ise staTus “2ND ELR 211-2 19/02/2024. 03-40 ADMITTED, SR-2F 203-2 STArUs aS -ON-22702/2078 “AMOUNT S80 HEALTH cane senvices Be.) x Bed Charges 32100.00 2 nology Lab 4595-00 3 Medicine's Consumables 5394500 4 * Choudhary & Tean (Oncology Visi. chgtge 5000.00 5 Admission / File Charges : 350.00 é GST Cha¥ges. 0p-xoom Reatass. 275.00 Total Bill Amount 6265.00 Net Receivable agount 76265.00 a van en oe Credit Bill Towards > CARE HEALTH INSURANCE LIMGTED Re. 76265,00(supeee SEVENTY SI THOUSAND Tho HUNDRED SIXTY FIVE ONLY)PROVISIONAL BILL BREAK UP me | meee eESee wet ton Ba _ = mgr ward/Bed No- pate Gharges/Day No. of Days Amount (Ra.) ee ee ae Zitat tae ae et eer coma) 8 Come TE aes) veyearaees ue oe ae a (one cerca aS) wsieaaiet eons 8-8 otal Amount 5/231 err 28? age ¥o- = patch No EXP: 5252/0738 30/31/2028 323029 30/07/2026 apeis5es 30/11/2026 pate 19/02/2024 stor) Ba 59105071, 25/10/2025 pate 19/02/2024 Sp-627a 31/10/2025 Paros 31/08/2023 Popol 31/20/2025 epreten 31/09/2028 Seana? 31/08/2025 sxepgpan 23708/2028 1D a3? 30/10/2025 A439 33/10/2024 3h eee gi/or2028 1 z aangoose 21/22/2081 3 1 Byyoirauze = 3°Re + mwie/2024001617 Fi trro/2023026574 ; Nae MRS. THU Age Lone Se Be ea ick HPS-It461 30/06/2075 4 CAP Tvit-e 800ag(hind bio.) 0-577 31/16/2025 1 . SE tee Shears merisies Vines | 8 aa SUR SYRINGE =5ML DISPOVi iK2368 30/09/; 9 7 Sen svete