DATE …………………………………………………………….DAY……………………………………………………………………..

PATIENT’S SUMMARY

TOTAL PATIENTS NO. OF PATIENTS FREE PATIENTS

CONCESSION FEE PATIENT

ANY OTHERS PATIENT

RECEIPT SUMMARY

OUT DOOR PATIENT FEE

MAJOR OPERATION FEE

PROCEDURE FEE

ULTRASOUND FEE

ECG FEE

NEBULIZING FEE

FOLLYS CHARGES

ROOM CHARGES

OTHER CHARGES

EXPENSES SUMMARY

EXPENSE FOR WORK AMOUNT Rs/-Rs/-Rs/Rs/-Rs/-Rs/-Rs/-

TOTAL EXPENSES Rs/-TOTAL RECEIPT AND EXPENSES SUMMRY

TOTAL RECEIPT Rs/-TOTAL EXPENSES Rs/-FINAL TOTAL Rs/-