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Estimate for Ankle Amputation Surgery

The document is an estimate form for a surgery, specifically an ankle amputation for an 80-year-old female patient, Mr. Mahesh Prajapat. The total estimated cost for the treatment is approximately Rs. 82,600, which includes charges for bed, nursing, medicines, consultations, and surgical fees. The patient has been informed that the final cost may vary and must deposit the full amount prior to the surgery.

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vikash
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66 views1 page

Estimate for Ankle Amputation Surgery

The document is an estimate form for a surgery, specifically an ankle amputation for an 80-year-old female patient, Mr. Mahesh Prajapat. The total estimated cost for the treatment is approximately Rs. 82,600, which includes charges for bed, nursing, medicines, consultations, and surgical fees. The patient has been informed that the final cost may vary and must deposit the full amount prior to the surgery.

Uploaded by

vikash
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd

ESTIMATE FORM

DATE:- 4/24/2025
CASH
[Link]. [Link] Prajapat AGE/GENDER:- Female/80 Years
BED CATEGORY:- GNW MOB :- 6202964360
IP NO/REG NO:- ARSH59686

DOCTOR NAME DR. NAVNEET NISHCHAL, MBBS MCH ,[Link]

SURGERY NAME ANKLE AMPUTATION

LOS 3 BED GNW CODE

Details of Estimate Calculation:-


Particulars: Amount (in Rs.) Remarks

Bed charge 6000 2000 PER DAY

RMO+NURSING+DIET CHARGES 3600 1200 PER DAY

Medicines & Consumption 20000 Approx

IPD CONSULTATION 500 AS PER NO OF DOCTOR ROUND

SURGEON CHARGES 25000

OT CHARGES 12500

ANAESTHETIST CHARGE 5000

OT ASSISTANT 2500

LAB CHARGES 3000 APPROX

Radiology Charges 2500 APROX

others(Doctor's fees/Equipment Charges) 2000 APPROX

TOTAL ESTIMATE 82600 APPROX


R/B

Grand Total ESTIMATE 82600 APPROX

I have been explained (in detail) about the cost of treatment . I have been also explained that the estimated cost of treatment of

treatment may increase or decrease after treatent. I undertake to deposit the full amount before the surgery /treament. In view of
not depositing the amount , the hospital has full authority to postpone/stop/hold my patient's surgery /medical treatment/to
discharge my patient and I/My family shall cooperate in such stances.

Doctors Name Attendants Name & Signature Staff Name & Signature

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