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    Hospital Bill 1

    Uploaded by

    Süññy Mäñè
    This document appears to be a hospital bill that includes: 1. Hospital contact information at the top including name, address, phone number and email. 2. Patient information such as name, ID number, admission and discharge dates. 3. A table breaking down charges by category such as room rent, ICU charges, investigations, and totals for billed amount and amount received. 4. Signatures at the bottom to acknowledge receipt of payment towards settling the bill.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Hospital Bill 1

    Uploaded by

    Süññy Mäñè
    298 views2 pages
    This document appears to be a hospital bill that includes: 1. Hospital contact information at the top including name, address, phone number and email. 2. Patient information such as name, ID number, admission and discharge dates. 3. A table breaking down charges by category such as room rent, ICU charges, investigations, and totals for billed amount and amount received. 4. Signatures at the bottom to acknowledge receipt of payment towards settling the bill.

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    This document appears to be a hospital bill that includes: 1. Hospital contact information at the top including name, address, phone number and email. 2. Patient information such as name, ID number, admission and discharge dates. 3. A table breaking down charges by category such as room rent, ICU charges, investigations, and totals for billed amount and amount received. 4. Signatures at the bottom to acknowledge receipt of payment towards settling the bill.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    298 views2 pages

    Hospital Bill 1

    Uploaded by

    Süññy Mäñè
    This document appears to be a hospital bill that includes: 1. Hospital contact information at the top including name, address, phone number and email. 2. Patient information such as name, ID number, admission and discharge dates. 3. A table breaking down charges by category such as room rent, ICU charges, investigations, and totals for billed amount and amount received. 4. Signatures at the bottom to acknowledge receipt of payment towards settling the bill.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Hospital Name & Speciality

    Address
    POSTCODE
    Phone Number
    Email

    Bill no. Bill Date and Time


    PAN Number Service Tax No
    IP No Bed Number
    Date and time: Admission Date and time: Discharge
    Patient Name Member ID / Card No / IP number:
    Patient's address Patient's Contact No

    Particulars Gross Amount Discount Net Amount


    ROOM RENT SERVICES
    ICU CHARGES
    NURSING / RMO
    SERVICES
    CONSULTANT VISITS
    MEDICINE &
    CONSUMABLES
    INVESTIGATION CHARGES
    SURGERY / PROCEDURE
    CHARGES
    IMPLANTS AND
    EQUIPMENTS
    MISCELLANEOUS
    CHARGES
    PACKAGE CHARGES
    ANY OTHER (SPECIFY)
    BILLED AMOUNT

    Advance payment / deposit voucher receipt details:1.________________2.


    ________________________

    Received Rs. ………………….. (Rupees …………………………… ...only) by cash / cheque


    No………………………...on date …………………… ……...towards settlement of the above bill.

    Patients Signature Authorized Signatory- hospital with seal


    DETAILED BREAKUP FORMAT

    Patient Name Bill Date


    Provider Bill Number Address /PAN Number
    Registration No. Service Tax
    IP No / Bed Number

    Billing Details

    SI No Date Code Particulars Rate Nos(Unit) Amount


    1 101001 Oo/00/89 General Ward Charges 500 1 500
    2 401001 XXX medicine 50 2 100
    3 401001 XXX Medicine Return 50 1 -50
    4 23231 XXX investigation - CBC 300 1 300
    5 22434 XXX consultant charge 500 1 500

    Patients Signature Authorized Signatory-


    Hospital with seal

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