BILL CUM RECEIPT

Duplicate Copy
Patient Category : Cash Invoice No. : INV-O-170-19008503
MRN : 17561712180232 Invoice Date : March 9, 2019 10:08
Patient Name : Mrs SUVRA KUMAR Visit No. : OP-001
Gender / Age : FEMALE/35 Years 3 Months Charge Class : OPD
Contact No : 8509066863
Address ANDAL, SCHOOL PARA, ANDAL, Corporate Sponsor : IQ City Narayana Multispeciality
: Hospital
West Bengal, India - - 713321
Plan Name : IQ CITY STAFF DEPENDANT
PLAN
Corporate Sponsor (Account : Receivables-I000002
Number)

Description Unit Rate Qty Discount(Rs) Amount (Rs) Total Amount (Rs)
Laboratory

PROTHOMBIN TIME & INR 275.00 1.00 110.00 165.00

HEMOGLOBIN / Hb% 60.00 1.00 24.00 36.00
HIV, HBsAg, HCV (RAPID) 1,540.00 1.00 616.00 924.00
THYROID PROFILE- 1 (T3 T4 TSH) 750.00 1.00 300.00 450.00
BT CT 120.00 1.00 48.00 72.00
BLOOD FOR GROUPING 250.00 1.00 100.00 150.00
BLOOD SUGAR F 80.00 1.00 32.00 48.00
UREA & CREATININE 350.00 1.00 140.00 210.00
Laboratory Total 2,055.00

Total Hospital Charges for Services/Items rendered 1,370.00 2,055.00 2,055.00

Total Bill Amount Including Taxes before round off 2,055.00

Final Bill Amount including Taxes 2,055.00
Amount in words : Rupees Two Thousand Fifty Five Only

Sl No Receipt No Amount Mode Ref No Instrument Instrument Date

Details
1 RCP-1701925771 2,055.00 Cash NA NA NA
Total 2,055.00

Balance Details
Gross bill amount : 2,055.00
Net Amount : 2,055.00

Prepared By Argha Das, IQCT1530 Prepared On 09/03/2019 10:08

Generated By Arup Kumar / Arup Kumar, IQCT1194 Generated On 09/03/2019 20:18
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 Amount Paid : 2,055.00
Balance To Pay : 0.00

Prepared By Argha Das, IQCT1530 Prepared On 09/03/2019 10:08

Generated By Arup Kumar / Arup Kumar, IQCT1194 Generated On 09/03/2019 20:18
Page 2 of 2