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Hospital Bill Format

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22K views

Hospital Bill Format

Thank you for your cooperation and prompt payment. We wish you a speedy recovery. Please contact us if you need any further assistance.

Uploaded by

sandee1910
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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KIFY HOSPITAL

Danavaipeta
Rajahmundry
Phone:85000 23456
GST No - 37AAMHK6641M1ZL
In Patient Final Bil

Bill No:   FB3147                   Bill Date:  01-Feb-2021


  04:25PM

Kalagara Sridevi (IP3149)


Name of Patient________________________________________________________________, 49/F
Age/Sex______,

2-19/1,Nandarada,Rajanagaram Mandal ,533292


Address_____________________________________________________________________________________,

23-Jan-2021 05:24AM
Date / Time of Admission____________________________, Date / Time of Discharge_____________, 
01-Feb-2021 03:45PM

Name of Treating Doctor____________________________________, Department________________, 
DR. Karuturi Subrahmanyam INTERNAL MEDICINE

Accommodation Type______________________________________, Room No___________________, 
In-Patient 304

Diagnosis:___________________________________________________________________________, 
Internal Liver Infection

Code  Billing Heads  Rate  Quantity  Amount in Rs. 


1  Room Rent    650   10   6500
2  Nursing Charges    250   10   2500
3  RMO Charges    150   10   1500
4  IV Fluids Administration Charges       
5  Blood Transfusion  Administration Charges       
6  Injection Charges    350   18   6300
7  Sweeping  And Cleaning
  Charges 100 10 1000
  Total Room Rent Services       
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    500   10   5000
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       
77  X-Ray  
300 2  600 
8  ECG  
150 2  300 
9  Blood Test  
600 10  6000 
10  Dialysis       
11  Chemotherapy       
12  Radiotherapy       
13  Cost of Artificial Limbs       
14  Cost of Implants       
  Total of Other Expenses       
  Grand Total       
29,700
  Patient Paid Amount       
29,700
  Balance      NIL  
       

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