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Final - Hospital Bill Format

The document is a bill from Janta Hospital detailing the charges for a patient named Harsh Chunara for treatment of viral infections, fever, and cough from October 12th to 15th, 2019. The bill includes charges for room rent, nursing care, blood transfusion administration, medicines and drugs, and other expenses totaling 6,700 Indian rupees. All charges were paid by the patient so there is no remaining balance.

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17K views2 pages

Final - Hospital Bill Format

The document is a bill from Janta Hospital detailing the charges for a patient named Harsh Chunara for treatment of viral infections, fever, and cough from October 12th to 15th, 2019. The bill includes charges for room rent, nursing care, blood transfusion administration, medicines and drugs, and other expenses totaling 6,700 Indian rupees. All charges were paid by the patient so there is no remaining balance.

Uploaded by

H C
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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JANTA HOSPITAL

Bill No:    102748                Bill  Date: 15th Oct 2019  

Harsh Chunara
Name of Patient________________________________________________________________, M
Age/Sex______,

Vasna, Ahmedabad
Address_____________________________________________________________________________________,

12th Oct 2019 15th Oct 2019


Date / Time of Admission____________________________, Date / Time of Discharge_____________, 
Kamal Shah General
Name of Treating Doctor____________________________________, Department________________, 

Accommodation Type______________________________________, Room No___________________, 
Viral infections fever and cough
Diagnosis:___________________________________________________________________________, 

Code  Billing Heads  Rate  Quantity  Amount in Rs. 


1  Room Rent    2000   1   2000
2  Nursing Charges    500   1   500
3  RMO Charges       
4  IV Fluids Administration Charges       
5  Blood Transfusion  Administration Charges    1000   1   1000
6  Injection Charges       
7  Similar expenses as Above       
  Total Room Rent Services        3500
1  ICU Rent       
2  ICU Nursing Expenses       
3  ICU RMO charges       
4  IV Fluids Administration Charges       
5  Blood Transfusion  Administration Charges       
6  Injection Charges       
7  Similar expenses as Above       
  Total ICU Services       
1  Surgeon Charges       
2  Anesthetist Charges       
3  Medical Practitioner Charges       
4  Consultants Charges       
5  Specialist Charges       
  Total Professional Fee       
1  Anesthesia       
2  Blood       
3  Oxygen       
4  Operation Theater Charges       
5  Surgical Appliances       
Code  Billing Heads  Rate  Quantity  Amount 
66  Medicines and Drugs   
2500 1   
2500
77  Diagnostic Materials       
8  General Investigations       
9  Specialized Investigations       
10  Dialysis       
11  Chemotherapy       
12  Radiotherapy       
13  Cost of Artificial Limbs       
14  Cost of Implants       
  Total of Other Expenses  700  1  700 
  Grand Total      6700 
  Patient Paid Amount      6700 
  Balance      0  
       

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