DUPLICATE
BILL CUM RECEIPT
Mazumdar Shaw Medical Centre, Bangalore- FINANCE-BF
No. 258/A, Bommasandra Industrial Area, , Karnataka, India -560099
Patient Name : Mr Ganesh Kumar Bill No : IA100223L004949
Patient MRN : 10020001698337 Date : 03-12-2023 07:50 PM
Gender|Age|DoB : male|57y 8m|17/03/66 Tariff Class : OPD
Patient Phone No : 7349469769 Consultant : Dr. Viju Wilben V
Address : # 248 madapatna haragadde post , Jigani, Bangalore Visit No : OP-001
Urban, Karnataka, India, 560105
Particulars Date Qty Unit Rate Amount(Rs)
medical & surgery
1. Left side upper eyelid surgery | Dr. Sushma Tejwani 03-12-2023 1 550.00 550.00
2. Blepharoplasty often means removing excess skin, muscle 03-12-2023 1 240.00 240.00
and underlying fatty tissue | Dr. Sushma Tejwani 03-12-2023 1 3,300.00 3,300.00
Total 4,090.00
service
3. TonometrVisual Acuity Test / A-Scan / Biometry Test / Pupil Dilation 03-12-2023 1 3,210.00 3,210.00
Slit -Lamp Exam / Retinal Exam / Applanation Tonometry Total 3,210.00
Total Hospital Charges for Rendered Services/Items : 7,300.00
GSTIN: 29AABCN1685J1Z4 Total Bill Amount Including Taxes before round off : 7,300.00
Sponsor Payable : 0.00
Patient Round Off : 0.00
Patient Payable : 7,300.00
Amount in words: Rupees Seven Thousand Three Hundred Only
Receipt No. Receipt Date Mode Reference No. Amount(Rs)
1. RCPO-1002-2312004108 03-12-2023 07:50 PM E_WALLET 5012777212898 7,300.00
Total 7,300.00
Balance Details
Gross bill amount : 7,300.00
Sponsor Amount : 0.00
Net Amount : 7,300.00
Amount Paid : 7,300.00
Balance To Pay : 0.00
Prepared By: Shivamurthy C R, 334921 | Prepared On: 03-12-2023 19:50 | Scan to download NH Care app
Published By: Administrator, admin | Published On: 02-01-2024 15:51 | Access your Lab reports,
prescription and book appointment
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