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DISCHARGE BILL

Packet No:
PAN No: AAAJH0463L TIN No: 05014786026
Bill No: 18-19CR9256 Date:
Name: Udaybeer Age: 40
Address: Dabkikala Haridwar Haridwar, Sponsor: ESIS
Uttarakhand, India
Insurance No.: 6110733552 Consultant: Dr. Reshma Kaushik
UHID No: 2435364 Admission date:
IP No: 18/40215 Discharge date:
No. Days: 4 Category:

Investigation & Procedure S.No. Rate No. Amount


(Rs.) Times (Rs.)
Blood Grouping, X-Match & Reserve HC 450.00 1 450.00
Fresh Frozen Plasma (Process Charge) 1783 800.00 8 6400.00

Packed Red Blood Cells (Process Charge) 1782 1450.00 3 4350.00

Platelet Concentrate (Process Charge) 1784 1500.00 7 10500.00


Basic Studies (Cell Count, Protein, Sugar, 1736 270.00 1 270.00
Gram Stain, India Ink Preparation And
Smear For Afp)
Culture And Sensitivity-Bacterial 1739 225.00 3 675.00
CT Head-Without Contrast 1637 900.00 1 900.00
Charges For Sim. Vent. Filter HC 440.00 4 1760.00
Close Suction HC 1200.00 4 4800.00
Dvt Pump ( Per Day) HC 550.00 4 2200.00
E.T. Tube With Suction HC 650.00 4 2600.00
Glucometer HC 55.00 4 220.00
Nebulizer Kit HC 120.00 4 480.00
Neck Line HC 385.00 4 1540.00
Ripple Mattress HC 440.00 4 1760.00
Syring Pump HC 100.00 4 400.00
Tegaderm Small HC 25.00 4 100.00
Ventilation-Icu HC 531.00 4 2124.00
C.V.P. Line Procedure HC 1000.00 4 4000.00
Cut Open HC 330.00 4 1320.00
Eeg Recording HC 330.00 4 1320.00
Intercostal Drainage HC 330.00 4 1320.00
Coronary Care With Cardiac Monitoring HC 750.00 4 3000.00
(Room Rent Extra)
O2 Therapy HC 20.00 4 80.00
Arterial Blood Gas Analysis 1507 476.00 1 476.00
Albumin. 1461 21.00 1 21.00
Creatinine 1447 63.00 3 189.00
Liver Function Test. 1513 259.00 1 259.00
Potassium (K+) 1482 58.00 4 232.00
Prothrombin Time (P.T.) 1492 127.00 3 381.00
Sodium (NA+) 1481 58.00 3 174.00
Urine Complete Routine And Microscopy 1383 40.00 1 40.00

Complete Haemogram 1394 155.00 2 310.00


ESR. 1392 29.00 1 29.00
Haemoglobin (Hb) 1389 21.00 3 63.00
Rapid Test For Malaria(Card Test) 1407 51.00 1 51.00
PCV (Packed Cell Volume) 1398 15.00 3 45.00
Platelet Count 1395 55.00 4 220.00
AFP 1541 345.00 1 345.00
Chloride. 1531 69.00 1 69.00
ADA HC 500.00 1 500.00
Automated Blood & CSF Culture HC 1100.00 1 1100.00
Blood Film For Malaria HC 200.00 1 200.00
Dengue Virus Antibodies(Igg/Igm) HC 800.00 1 800.00
Gram Stain * HC 200.00 1 200.00
Hepatitis C Virus Quantitative HC 8000.00 1 8000.00
Microscopy For Afb (Zn Stain) HC 200.00 1 200.00
Procalcitonin (Elfa) HC 2000.00 1 2000.00
Scrub Typhus HC 650.00 1 650.00
Scrub Typhus Detect Igm HC 1100.00 1 1100.00
Urea Nitrogen (BUN) 1446 62.00 2 124.00
ECG 590 50.00 1 50.00
Debridement Of Wounds 373 3000.00 1 3000.00
Consultation- For Inpatients 2 300.00 8 2400.00
Ultrasound Abdomen 1591 323.00 1 323.00
X Ray Chest PA 1608 60.00 2 120.00
Total : 76240.00

Bed Charges Rate(Rs.) No.Day


General Ward 1000.00 4 4000.00
Total Bed Charges : 4000.00
Total Hospital Charges(A) : 80240.00

Medicine Bill
Kalptaru Druges Store Detail Attached 57183.00
Other Charges .00
Total Medicine Bill(B)

Total Hospital Charges(A) 80240.00


Total Medicine Bill(B) 57183.00
Total Implant Bill(C) .00
Total Amount(A+B+C) 137423.00
Outstanding Amount 137423.00

Rupees: One Lacks Thirty Seven Thousand Four Hundred Twenty Three Only
1878
IN No: 05014786026
8/13/2018
Male

Dr. Reshma Kaushik


8/9/2018
8/13/2018
General

Total
Amount
76240.00

4000.00
80240.00
57183.00