PROVISIONAL BILL

Patient Category : Corporate Bill No. : INV-DRAFT-JP001-22013318

MRN : JHN000431452 Bill Date : August 29, 2022 16:27
Patient Name : Mrs RUCHI SRIVASTAVA Visit No. : IP-001
W/O : Mr. MAYANK SRIVASTAVA Charge Class : MULTI
Gender / Age : FEMALE/51 Years GSTIN : 09AACCJ9811D1ZM
Discharge Type : Normal Discharge SAC : 99931
Contact No : 9873254362 Currently Admitted Under : Dr. Sanchita Ghonge Dube
Address : A-137 SEC-92, NOIDA, NOIDA, Admission date : 29/08/2022 08:28
: UTTAR PRADESH, INDIA - - 201304 Discharge Date : 29/08/2022 15:24
Ward/Bed : OBGY-3F/3402-OBGY-TRIAGE(2)
Corporate Sponsor : Greater Noida Authority
Plan Name : Greater Noida Authority
Corporate Sponsor (Account Number) : Receivables-G000005
Sponsor GSTN :

Description Date Unit Rate Qty Amount(Rs)

Bed Charges
BED CHARGES -DAYCARE(4HRS to 8 HRS) | Dr. Sanchita Ghonge 29-08-2022 2,400.00 1 2,400.00
Dube
Bed Charges Total 2,400.00
Consultation
VISITS CHARGES | Dr. Sanchita Ghonge Dube 29-08-2022 400.00 1 400.00
Consultation Total 400.00
Histopathology
SMALL SPECIMEN BIOPSY | Dr. Sanchita Ghonge Dube 29-08-2022 1,900.00 1 1,900.00
Histopathology Total 1,900.00
Investigation
BODY FLUIDS FOR MALIGNANT CYTOLOGY | Dr. Sanchita Ghonge 29-08-2022 1,000.00 1 1,000.00
Dube
Investigation Total 1,000.00
Miscellaneous
THERAPEUTIC DIET CHARGES 29-08-2022 to 29-08-2022 800.00 1 800.00
Miscellaneous Total 800.00
Procedure
ANAESTHESIA CHARGES | Dr. ANAESTHESIA TEAM 29-08-2022 3,581.00 1 3,581.00
DILATATION OF CERVICAL CANAL | Dr. Sanchita Ghonge Dube 29-08-2022 350.00 1 350.00
DILATION & CURETTAGE | Dr. Sanchita Ghonge Dube 29-08-2022 3,000.00 1 3,000.00
ENDOCERVICAL CURETTAGE | Dr. Sanchita Ghonge Dube 29-08-2022 1,500.00 1 1,500.00
HYSTEROSCOPY DIAGNOSTIC | Dr. Sanchita Ghonge Dube 29-08-2022 6,000.00 1 6,000.00
OT CHARGES | Dr. Sanchita Ghonge Dube 29-08-2022 8,680.00 1 8,680.00
OT GASES | Dr. Sanchita Ghonge Dube 29-08-2022 543.00 1 543.00
Procedure Total 23,654.00
Consumables
Catheter Mount (Romsons) 29-08-2022 485.00 1 485.00
Disp. Surgical Clipper Blade (9680 3M) ,.,Balde 29-08-2022 776.00 1 776.00
Disp. Trolley Cover 140cmX150cm(Apex Surgical) 29-08-2022 115.00 2 230.00
Disposable Apron 50" 29-08-2022 85.00 3 255.00
Disposable Panty ,.,Universal 29-08-2022 20.00 3 60.00
ECG Electrodes Adult (MLGLT-01) Medico 50'S 29-08-2022 25.00 10 250.00
Flexi Mask Adult Romsons 29-08-2022 302.00 1 302.00
Gloves Examination Latex (L) Pairs ,.,Lage 29-08-2022 20.00 6 120.00
Gloves-Sterile 6.0-Surgicare ,.,6 29-08-2022 80.00 3 240.00
Gloves-Sterile 6.5-Surgicare 29-08-2022 80.00 2 160.00
Gloves-Sterile 7.0-Surgicare ,.,7 29-08-2022 80.00 3 240.00

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Patient Details : JHN000431452 / Mrs RUCHI SRIVASTAVA / FEMALE / 51 Bill No. : INV-DRAFT-
Years 7 Days JP001-22013318

Description Date Unit Rate Qty Amount(Rs)

Consumables
HME Filter (352/5877) -COVIDEN 29-08-2022 445.00 1 445.00
IV Cannula (Mediflon) 20 G - Medikit ,.,20G 29-08-2022 287.00 1 287.00
Intrafix Safeset 180Cm (I.V.Set) B Braun 29-08-2022 294.00 1 294.00
Nasopharyngeal Air Way No 7.5 Romsons 29-08-2022 441.00 1 441.00
Romolene(Ryles Tube) Size : 16 (Romsons) 29-08-2022 77.00 1 77.00
Sofy Bodyfit AntiBacteria XL (7's) ,.,XL 29-08-2022 63.00 1 63.00
Suction Catheter No.10 Romsons 29-08-2022 73.00 2 146.00
Surgical GlovesEncore Microptic Powder Free 6.5-Ansell 29-08-2022 104.00 2 208.00
Syringe 1Ml (Tuberculin) 26G 100'S (Hmd) ,.,1Ml 29-08-2022 8.00 1 8.00
Syringe Dispovan With Needle, 10Ml 50'S (Hmd) 29-08-2022 11.00 1 11.00
Syringe Dispovan With Needle, 10Ml 50'S (Hmd) ,.,10Ml 29-08-2022 11.00 2 22.00
Syringe Dispovan With Needle, 2Ml 100'S (Hmd) 29-08-2022 4.95 5 24.75
Syringe Dispovan With Needle, 2Ml 100'S (Hmd) ,.,2Ml 29-08-2022 4.50 1 4.50
Syringe Dispovan With Needle, 5Ml 100'S (Hmd) 29-08-2022 8.50 2 17.00
Tegaderm 1623 3M 29-08-2022 94.00 2 188.00
Under Pads D-Drytex (Romsons) ,.,60cm 29-08-2022 154.00 3 462.00
Vein-O-Line Size : 200Cm Romsons 29-08-2022 397.00 1 397.00
Velfix-T 7*9CM (Ref 5503) {Tegaderm 1633} Datt ,.,1633 29-08-2022 157.00 1 157.00
Consumables Total 6,370.25
Drugs
Altacef 1.5gm Inj (Cefuroxime) Glenmark ,Injection,1.5Gm 29-08-2022 476.00 1 476.00
Altacef 500mg Tab 10's (Glenmark) ,Tablet,500Mg 29-08-2022 104.00 -10 -1,040.00
Altacef 500mg Tab 10's (Glenmark) ,Tablet,500Mg 29-08-2022 104.00 10 1,040.00
Artacil 50mg/5ml Inj (Atracurium) Neon 29-08-2022 288.00 1 288.00
Avashield Handrub 100ml (CHG) Metro Pharmaceuticals ,Bottle,100ml 29-08-2022 260.00 1 260.00
Cremaffin Liquid (Mixed Fruit) 225 ml (Abbott) ,Syrup,225 ml 29-08-2022 232.12 1 232.12
Cremaffin Liquid (Mixed Fruit) 225 ml (Abbott) ,Syrup,225 ml 29-08-2022 232.12 -1 -232.12
Dexaril 8mg/2ml Inj (Dexamethasone) Alkem 29-08-2022 10.45 1 10.45
Easycainne Jelly 2% 30gm (Lignocaine) Aespire ,Jelly,30GM 29-08-2022 35.10 1 35.10
Emeset 4mg/2ml Inj (Ondansetron) Cipla 29-08-2022 14.53 1 14.53
Emeset 4mg/2ml Inj (Ondansetron) Cipla ,Injection,4mg/2ml 29-08-2022 14.53 1 14.53
Fentanyl Citrate 2mL INJECTION (50mcg/ml) 29-08-2022 56.40 1 56.40
Fresofol 20 Ml Mct/Lct Inj (Propofol ) Fresenius 29-08-2022 179.60 1 179.60
Kabimol 100ml IV Unibag (Paracetamol) Fresenius Kabi 29-08-2022 600.00 1 600.00
Kineto DP Tab 10's (Systopic) ,Tablet,50+15 Mg 29-08-2022 8.60 -15 -129.00
Kineto DP Tab 10's (Systopic) ,Tablet,50+15 Mg 29-08-2022 8.60 15 129.00
Lidfast Jelly 2% 30Gm (Lignocaine) Samarth 29-08-2022 38.94 1 38.94
Mak Swab(Alcohol Swab) ,.,Swab 29-08-2022 2.20 3 6.60
Misoprost 200mg Tab 4's (Misoprostol) Cipla ,Tablet,200mg 29-08-2022 20.64 4 82.56
Myo-Pyrolate 3mg/5ml Inj (Glycopyrrolate+Neostigmine) Neon 29-08-2022 112.50 1 112.50
N.S. 100ml (Sodium Chloride 0.9%) Flexidrip (Otsuka) ,Fluid,100ml 29-08-2022 42.01 1 42.01
N.S. 500ml (Sodium Chloride 0.9%) Unibag Otsuka 29-08-2022 87.84 2 175.68
NS 1000ml Plastic (Otsuka) 29-08-2022 58.20 1 58.20
Pantocid 40mg Inj (Sun Pharma) ,Injection,40Mg 29-08-2022 55.30 1 55.30
Pantocid D Cap 10's (Sun Pharma) ,Capsule,40mg+30mg 29-08-2022 11.00 -10 -110.00
Pantocid D Cap 10's (Sun Pharma) ,Capsule,40mg+30mg 29-08-2022 11.00 10 110.00
Sevoflurane Abbott 250ml Bottle [new] 29-08-2022 34.87 20 697.34
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Patient Details : JHN000431452 / Mrs RUCHI SRIVASTAVA / FEMALE / 51 Bill No. : INV-DRAFT-
Years 7 Days JP001-22013318

Description Date Unit Rate Qty Amount(Rs)

Drugs
Sodium Chloride Irrigation 3000 Ml Bottle (Denis) Aqua Pulse 29-08-2022 526.00 2 1,052.00
Stimupil 10 ml Inj(Mephentermine) Psychotropics 29-08-2022 326.70 1 326.70
Vizylac Cap 15's (Unichem) ,Capsule,300mg 29-08-2022 4.61 15 69.15
Vizylac Cap 15's (Unichem) ,Capsule,300mg 29-08-2022 4.61 -15 -69.15
Drugs Total 4,582.44

Total Hospital Charges for Services/Items rendered 41,106.69

Amount in words. : Rupees Thirty Five Thousand Seventy Six Only

Balance Details
Gross bill amount : 41,106.80
Less discount : 6,030.80

Net Amount : 35,076.00

Patient Amount : 35,076.00
Deposit Balance : 0.00
Balance To Pay : 35,076.00

Please Note: Bed Charges are updated only up to the previous day. Amount indicated in this provisional bill could undergo changes at the time
of bill finalization.

Prepared By Parth Sarthi Prepared On Aug 29, 2022

Generated On 29/08/2022 16:27

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