FF-BIL-004 25-Nov-2018 11:24

ServiceTax Reg No : AACCS9646MSD005 Bill No. : ICR54573

Insurance Company : BAJAJ ALLIANZ INSURANCE Bill DateTime : 11/25/2018 11:23
TPA Name : MEDI-ASSIST INDIA PVT LTD UHID : SAH1.0000624722
Corp Name : ATTRA INFOTECH PVT LTD Age / Sex : 33 Year(s)/ Female
IP NO. : IPID.0161022 Bed : SPT311A
Patient Name : MRS PR AN AT I RAUTARAY Ward : NURSING STN 3RD FLR
Address : #49/50 Admit Date : 11/24/2018 10:08
, J P NAGAR V TH PHASE Discharge Date : 11/25/2018 11:22
BENGALURU,KARNATAKA
Doctor Name : Dr SUBHASH RC

SI.No Service Name Comp. Amt(Rs.) Pat Amt(Rs.)

1 Duty Doctor Fee 900.00 0.00

2 Room Rent 2,200.00 0.00
3 Consultations 2,250.00 0.00
4 Investigations 2,610.00 0.00
5 Procedure 200.00 0.00
6 Surgeon Fee 23,450.00 0.00
7 Anesthetist Fee 7,035.00 0.00
8 Operation Theatre 11,725.00 0.00
9 Nursing Charges 1,300.00 0.00
Service Totals 51,670.00 0.00
10 Pharmacy 2,880.66 0.00
11 Consumables 1,296.55 0.00
Service TotaIs 55,847.21 0.00
Hospital Discount 5,167.00 0.00
Bill Amount 50,680.00 0.00
Authorized Amount 44,580.00 0.00
Copay 0.00 5,000.00
12 Non Medical Expenses 0.00 1,100.00
Balance 0.00 6,100.00

Amount in Words :
Rupees six thousand one hundred only
User: MURALI