ESSENTIALITY CERTIFICATE

This is to certify that Mrs. CHILLARA ANNAPURNA (Admission No: IP1700290 &
UMR No: UMR1700777), W/o. SESHAGIRI RAO. The patient has been suffering from
Large Pericardial Effusion with Tamponade, Pericardiocentesis, Matted Cervical
Lymphadenopathy & Squamous Cell Carcinoma Metastasis primary lesion at Breast by
pet scan has been under treatment from 24-01-2017 to 03-02-2017 at “SENTINI
HOSPITALS”, D.No.54-15-5B & 5C, Near Vinayaka Theatre, Ring Road, Vijayawada-
8, Krishna Dist. And that the under mentioned medicines prescribed by me in this
connection were essential for the recovery and (Prevention of serious deterioration in the
condition) of the patient. The medicines are stocked in the hospital and do not include
proprietary prepare supply to patients for which cheaper substance and therapeutic value
are available or preparations which are primarily foods, toilets or disinfectants.

S.No. Bill Date BILL No. Particulars Amount

1 24-01-17 OOP276718 PHARMACY RECEIPT 1992
2 24-01-17 OOP276791 PHARMACY RECEIPT 295
3 24-01-17 OOP276897 PHARMACY RECEIPT 286
4 24-01-17 OOP276896 PHARMACY RECEIPT 324
5 25-01-17 OOP276962 PHARMACY RECEIPT 560
6 26-01-17 OOP277131 PHARMACY RECEIPT 5569
7 28-01-17 OOP277481 PHARMACY RECEIPT 645
8 29-01-17 OOP277702 PHARMACY RECEIPT 3822
9 30-01-17 OOP277803 PHARMACY RECEIPT 5340
10 30-01-17 OOP277954 PHARMACY RECEIPT 98
11 31-01-17 OOP278008 PHARMACY RECEIPT 5231
12 01-02-17 OOP278307 PHARMACY RECEIPT 169

Signature and Designation of Signature of the Medical the Officer

Authorized Medical Attendant in charge in the case of the Hospital

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 ESSENTIALITY CERTIFICATE
This is to certify that Mrs. CHILLARA ANNAPURNA (Admission No: IP1700290 &
UMR No: UMR1700777), W/o. SESHAGIRI RAO. The patient has been suffering from
Large Pericardial Effusion with Tamponade, Pericardiocentesis, Matted Cervical
Lymphadenopathy & Squamous Cell Carcinoma Metastasis primary lesion at Breast by
pet scan has been under treatment from 24-01-2017 to 03-02-2017 at “SENTINI
HOSPITALS”, D.No.54-15-5B & 5C, Near Vinayaka Theatre, Ring Road, Vijayawada-
8, Krishna Dist. And that the under mentioned medicines prescribed by me in this
connection were essential for the recovery and (Prevention of serious deterioration in the
condition) of the patient. The medicines are stocked in the hospital and do not include
proprietary prepare supply to patients for which cheaper substance and therapeutic value
are available or preparations which are primarily foods, toilets or disinfectants.

S.No. Bill Date BILL No. Particulars Amount

13 01-02-17 OOP278202 PHARMACY RECEIPT 5532
14 01-02-17 OOP278244 PHARMACY RECEIPT 140
15 02-02-17 OOP278381 PHARMACY RECEIPT 36
16 02-02-17 OOP278482 PHARMACY RECEIPT 1595
17 02-02-17 OOP278487 PHARMACY RECEIPT 2913
18 02-02-17 OOP278493 PHARMACY RECEIPT 57
19 03-02-17 OOP278558 PHARMACY RECEIPT 1861
20 03-02-17 FB1700520 IN PATIENT FINAL BILL 1,35,000
21 03-02-17 18327 HCG Pet-CT(UMR No.4257) 22500

GRAND TOTAL 193965

Total Amount of One Lakh Ninety Three Thousand Nine Hundred and Sixty Five Rupees

Signature and Designation of Signature of the Medical the Officer

Authorized Medical Attendant in charge in the case of the Hospital

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