MKW Bills

OPD RECEIPT
Name Age/Sex Reg. No. Address Consultant Referred By : : : : : : Mrs. SANJANA 29 YRS / FEMALE 25284 TC-815, RAGHUBIR NAGAR, NEW DELHI Contact No. ASHISH BAWA Date Dr. T.S. NARANG Receipt No. Units
: : : Rate
9999937812 9/Aug/2011 11:52:17 FRT/11-12/00045106 Amount (Rs.) 500.00 500.00 500.00 0.00 0.00
Particulars PROCEDURE CHARGES PHYSIOTHERAPY CHARGE (SWD to Back)
10.00 50.00 Total Amount Paid : Previous Bal. : Receivable Amt. :
Payment By
Cash
Received with thanks an amount of (Rupees) Fifty Only Sponsored By : MKW HOSPITAL 9/Aug/2011 11:52:17 Prepared By : Gunjan Arora
Signature
Printed By : Gunjan Arora
Reg. No. Name Age/Sex Address Contact No. Issue Date Receipt No.
: : : : : : :
GENERAL (OPD) 22963 Mrs. SANJANA 29 YRS / FEMALE TC-815, RAGHUBIR NAGAR, NEW DELHI 9999937812 09/Aug/11 8:54:00 AM FRT/11-12/00042670
Department Room No. Doctor / Unit Doctor Days Company Panel Fee Appoint. No.
: : : : : : :
ORTOPAEDICS 1 Dr. T. S. NARANG Tue Wed Fri MKW HOSPITAL Rs. 150 1
Printed By
: Ritu Lamba
Payment By : Cash Received with thanks an amount of (Rupees) One HundredFifty Only Sponsored By : MKW HOSPITAL 9/Aug/2011 8:54:00
Signature
: : : : : : :
: : : : : : :
ORTOPAEDICS 1 Dr. T. S. NARANG Tue Wed Fri MKW HOSPITAL Rs. 150 3
Printed By
: Roshan Lal
Signature
: : : : : : :
: : : : : : :
PHYSICIAN 10 Dr. R.S. SALUJA Mon Tue Thu Sat MKW HOSPITAL Rs 50 31
Printed By
: Roshan Lal
Signature
: : : : : : :
: : : : : : :
GYNECOLOGY 3 Dr. SEEMA SEHGAL Mon Tue Wed Thu Fri Sat MKW HOSPITAL Rs 50 51
Printed By
: Gunjan Arora
Signature
DL No. Name Rec. No. Doctor / Unit # 1 2
: 10(1427)20.21
TIN No. Date Payment Company Panel Batch 848 -
: : : : Exp. Date 01/Jan/14 01/Jun/12
07970308253 23/Jun/11 Card MKW HOSPITAL Item Rate 295.00 170.00 Qty. 1 1
: Mrs. SANJANA : PCI/11-12/00015244 : Dr. VINOD KUMAR

Particulars HEXILAC SILICON GEL 10GM WOMEN HORLICKS
PHRAM 1 7:03:41 PM
Amount 295.00 165.00
Generated By User
: :
Rajesh Mr. RAJESH
TOTAL :
ROUND :
460.00
0.00
Received With Thanks
Only Rupees 460
Signature
*All disputes subject to DELHI Jurisdication only *Medicines once sold will not be taken back *Cutting strips of tab/cap will not be taken back
DL No. Name Rec. No. Doctor / Unit # 1 2
: 10(1427)20.21
TIN No. Date Payment Company Panel Batch 848 NG1813
: : : : Exp. Date 01/Jan/14 01/Jun/12
07970308253 20/Jul/11 Card MKW HOSPITAL Item Rate 295.00 59.00 Qty. 1 1
: Mrs. SANJANA : PCI/11-12/00016580 : Dr. VINOD KUMAR

Particulars HEXILAC SILICON GEL 10GM PHEXIN DS SYRUP
PHRAM 1 7:22:09 PM
Amount 295.00 59.00
Generated By User
: :
Rajesh Mr. RAJESH
TOTAL :
ROUND :
354.00
0.00
Only Rupees 354
Signature
DL No. Name Rec. No. Doctor / Unit # 1 2 3 4 5
: 10(1427)20.21
TIN No. Date Payment Company Panel Batch 2142847 N648 ZHK1785 CA-2523 BNC0609
: : : : Exp. Date 01/Mar/12 01/May/13 01/Jan/13 01/Oct/12 01/Nov/12
07970308253 09/Aug/11 Cash MKW HOSPITAL Item Rate 11.43 6.52 5.95 1.67 8.80 Qty. 7 20 14 7 7
: Mrs. SANJANA : PCI/11-12/00014019 : Dr. T. S. NARANG

Particulars MOBRINE OD 15MG CAP 1*10 ULTRACET TAB 1*10 NUCOXIA-P TAB 1*10 CYRA 20MG TAB 1*10 AXBC CAP 1*10
PHRAM 1 9:52:46 AM
Amount 84.00 136.92 87.50 12.25 69.30
Generated By User
: :
Ashok Mr. ASHOK
TOTAL :
ROUND :
389.97
0.03
Only Rupees 390
Signature
DL No. Name Rec. No. Doctor / Unit # 1 2 3 4 5
: 10(1427)20.21
TIN No. Date Payment Company Panel Batch 2142847 BNC-0609 ZHL2239 AF1027 AF1033
: : : : Exp. Date 01/Mar/12 01/Nov/12 01/Apr/13 01/May/13 01/Oct/12
07970308253 17/Aug/11 Cash MKW HOSPITAL Item Rate 11.43 8.80 5.95 7.10 7.14 Qty. 7 7 14 20 20

Particulars MOBRINE OD 15MG CAP 1*10 AXBC CAP 1*10 NUCOXIA-P TAB 1*10 IROZORB TAB 1*10 REBOCAL TAB 1*10
PHRAM 1 11:50:41 AM
Amount 84.00 69.30 87.50 149.16 150.00
Generated By User
: :
Ajesh Mr. AJESH
TOTAL :
ROUND :
539.96
0.04
Only Rupees 540
Signature
DL No. Name Rec. No. Doctor / Unit # 1 2 3 4 5 6 7 8 9 10
: 10(1427)20.21
TIN No. Date Payment Company Panel Batch 848 -
: : : : Exp. Date 01/Jan/14 01/Jun/12
07970308253 17/Aug/11 Cash MKW HOSPITAL Item Rate 295.00 170.00 Qty. 1 1

Particulars HEXILAC SILICON GEL 10GM WOMEN HORLICKS
PHRAM 1 11:50:41 AM
Amount 295.00 165.00
Generated By User
: :
Ajesh Mr. AJESH
TOTAL :
ROUND :
460.00
-460.00
Only Rupees 0
Signature

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OPD RECEIPT

Particulars PROCEDURE CHARGES PHYSIOTHERAPY CHARGE (SWD to Back)

10.00 50.00 Total Amount Paid : Previous Bal. : Receivable Amt. :

DL No. Name Rec. No. Doctor / Unit # 1 2

TIN No. Date Payment Company Panel Batch 848 -

: : : : Exp. Date 01/Jan/14 01/Jun/12

: Mrs. SANJANA : PCI/11-12/00015244 : Dr. VINOD KUMAR

Amount 295.00 165.00

Rajesh Mr. RAJESH

Received With Thanks

Only Rupees 460

DL No. Name Rec. No. Doctor / Unit # 1 2

TIN No. Date Payment Company Panel Batch 848 NG1813

: : : : Exp. Date 01/Jan/14 01/Jun/12

: Mrs. SANJANA : PCI/11-12/00016580 : Dr. VINOD KUMAR

Amount 295.00 59.00

Rajesh Mr. RAJESH

Received With Thanks

Only Rupees 354

DL No. Name Rec. No. Doctor / Unit # 1 2 3 4 5

: : : : Exp. Date 01/Mar/12 01/May/13 01/Jan/13 01/Oct/12 01/Nov/12

: Mrs. SANJANA : PCI/11-12/00014019 : Dr. T. S. NARANG

Amount 84.00 136.92 87.50 12.25 69.30

Ashok Mr. ASHOK

Received With Thanks

Only Rupees 390

DL No. Name Rec. No. Doctor / Unit # 1 2 3 4 5

: : : : Exp. Date 01/Mar/12 01/Nov/12 01/Apr/13 01/May/13 01/Oct/12

: Mrs. SANJANA : PCI/11-12/00015115 : Dr. T. S. NARANG

Amount 84.00 69.30 87.50 149.16 150.00

Ajesh Mr. AJESH

Received With Thanks

Only Rupees 540

DL No. Name Rec. No. Doctor / Unit # 1 2 3 4 5 6 7 8 9 10

TIN No. Date Payment Company Panel Batch 848 -

: : : : Exp. Date 01/Jan/14 01/Jun/12

: Mrs. SANJANA : PCI/11-12/00015244 : Dr. T. S. NARANG

Amount 295.00 165.00

Ajesh Mr. AJESH

Received With Thanks

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