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Settled Invoice IB150523J002605

Mrs. Munni Thapliyal was admitted to the emergency ward of Dharamshila Narayana Superspeciality Hospital on October 21, 2023 for treatment. According to the bill, she received an injection, an ECG, blood tests, medicines, surgical supplies and an emergency consultation. The total hospital charges amounted to 1,082.22 rupees, which was covered fully by the Central Government Health Scheme. As the bill was paid in full by the sponsor, the patient was not required to pay anything.

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861 views2 pages

Settled Invoice IB150523J002605

Mrs. Munni Thapliyal was admitted to the emergency ward of Dharamshila Narayana Superspeciality Hospital on October 21, 2023 for treatment. According to the bill, she received an injection, an ECG, blood tests, medicines, surgical supplies and an emergency consultation. The total hospital charges amounted to 1,082.22 rupees, which was covered fully by the Central Government Health Scheme. As the bill was paid in full by the sponsor, the patient was not required to pay anything.

Uploaded by

thapliyalneeraj1985
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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FINAL BILL

Dharamshila Narayana Superspeciality Hospital- ONCOLOGY OPD AREA-


GF-BLOCK-A
VASUNDHRA ENCLAVE, NEAR NEW ASHOK NAGAR METRO STATION, New Delhi, Delhi, India
-110096

Patient Name : Mrs Munni Thapliyal Bill No : IB150523J002605


Patient MRN : 15050000114320 Date : 21-10-2023 12:47 PM
Gender|Age|DoB : female|64y 11m|10/11/58 Tariff Class : OPD
Patient Phone No : 9810227496 Admitted Under : Dr Prahladprasadagrawal
Address : H NO 214-215 BLOCK 10 KHICHRIPUR , New Delhi, Visit No : ER-003
Delhi, India, 110091 Admission Date : 21-10-2023 10:18 AM
Discharge Date : 21-10-2023 12:41 PM
Ward/Bed : EMERGENCY WARD-GF-BLOCK-B / 7

Plan: 1505_CGHS14(NABH)_CREDIT_PARENT |
Sponsor : CENTRAL GOVT HEALTH SCHEME (CENTRAL GOVT HEALTH SCHEME, 1329_C) |Sponsor Bill No : SB150523J001572 | Sponsor Payable : 1,082.22
Particulars Date Qty MRP Unit Rate Amount (Rs)
Administrative
1. I/D Injection Keloid (CGHS - 28) 21-10-2023 1 112.00 112.00
Total 112.00
Consultation
1. EMERGENCY CONSULTATION CHARGE 21-10-2023 1 350.00 350.00
Total 350.00
Diagnostics Non-Lab
1. ECG (CGHS code:590) 21-10-2023 1 175.00 175.00
Total 175.00
Laboratory Services
1. Blood Glucose Random( CGHS Code No. 1444) 21-10-2023 1 28.00 28.00
Total 28.00
MEDICINES
1. CLONAZEPAM-TABLET-0.5MG-CLONOTRIL- |2JC6K006 / 2025-11-30 (30049082) 21-10-2023 1 3.48 3.48 3.48
2. PANTOPRAZOLE-INJECTION-40MG-ZOVANTA- |PPQDA52 / 2024-11-30 (30049039) 21-10-2023 1 55.04 55.04 55.04
3. ONDANSETRON-INJECTION-8MG/4ML-PERISET- |EWI023002D / 2025-05-31 21-10-2023 1 26.70 26.70 26.70
(30049035)
Total 85.22
SURGICAL CONSUMABLES
1. I V CANNULA-.-22G-ULTRA 1201 POLYMED- |4118423G / 2028-06-30 (90183920) 21-10-2023 1 185.00 185.00 185.00
2. TRANSPARENT ADHESIVE DRESSING-P0675P W/O PAD PLAIN-6CM X 7.5CM- 21-10-2023 1 147.00 147.00 147.00
RELIDERM I.V GUJARAT HEALTH CARE- |239018 / 2026-08-31 (30059040)
Total 332.00

Total Hospital Charges for Rendered Services/Items : 1,082.22


GSTIN: 07AAATD0451G1Z7 Total Bill Amount Including Taxes before round off : 1,082.22
Sponsor Payable : 1,082.22
Patient Round Off : 0.00
Patient Payable : 0.00
Amount in words: Rupees Zero Only

Balance Details
Gross bill amount : 1,082.22
Less Discount : 0.00
Sponsor Amount : 1,082.22
Net Amount : 0.00
Amount Paid : 0.00
Page 1 of 2
Patient Name :Mrs Munni Thapliyal (15050000114320)
Bill No : IB150523J002605

Balance To Pay : 0.00

Prepared By: Vishal ., 367522 | Prepared On: 21-10-2023 12:47 | Scan to download NH Care app
Published By: Administrator, admin | Published On: 21-10-2023 12:47 | Access your Lab reports,
prescription and book appointment

Page 2 of 2

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