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26-Nov Invoice

This document is a duplicate bill of supply for medical services provided to Ms. Smita Bhargava, totaling Rs. 5000. The bill includes various tests such as Urine Culture, CBC, Liver Function Test, and Blood Culture, all paid via UPI. The bill is dated 26/11/2024 and issued by Max Super Speciality Hospital-Vaishali.

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nirupameng2021
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60 views1 page

26-Nov Invoice

This document is a duplicate bill of supply for medical services provided to Ms. Smita Bhargava, totaling Rs. 5000. The bill includes various tests such as Urine Culture, CBC, Liver Function Test, and Blood Culture, all paid via UPI. The bill is dated 26/11/2024 and issued by Max Super Speciality Hospital-Vaishali.

Uploaded by

nirupameng2021
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Duplicate Bill of Supply

Mobile No. : 9810013298


:
*200619065*
Patient Name : Ms. Smita Bhargava
Bill Date : 26/11/2024 11:41AM
Age/Sex : 41 years 4 months / Female
MaxId / SSN : VSLI.619065 / 200619065
Address : R-5/12, 12, block 5, sector 5, raj nagar
Bill No / Receipt No : VACS3132989 / VARC3020958

Email ID : [email protected] GSTN Bill : CR24OD0000300503

PAN/Form60 : GSTN No : 09AACCC4239Q1Z6

Referred By : Ajay Kumar Gupta Passport No :

Sl.N Services SAC Qty Base Tariff Discounts Net Amount Tax Amt Bill Amount
o. Price(Rs.) Price(Rs.) (Rs.) (Tax %) (Rs.)
Urine Culture & 999316
1 Sensitivity 1 1250.00 1250.00 0.00 1250.00 1250.00

CBC (Complete Blood 999316


2 Count),EDTA 1 550.00 550.00 0.00 550.00 550.00

Liver Function Test 999316


3 Profile,Serum (R) 1 1250.00 1250.00 0.00 1250.00 1250.00

Paired Blood Culture & 999316


4 Sensitivity 1 1950.00 1950.00 0.00 1950.00 1950.00

Total : 0.00 5000.00 0.00 5000.00

Paid by Patient : 5000.00


Amount in Words : Rupees five thousand only collected from patient

Sum Of Rs. 5000.00 received with thanks from Ms. Smita Bhargava

Payment Mode(s)

UPI for Rs.5000.000(UPI No. :0, Card Name : HDFC UPI, Approval Code - 370024858, Tr. ID-370024858,Dt-26-11-2024
12:00 ) Signature

Signature of Patient/Next of Kin Biswanath Chowdhury

Place of Supply : Uttar Pradesh-( 09) PAN No. : AACCC4239Q

Company Name : Max Super Speciality Hospital-Vaishali (A unit of Crosslay Remedies Ltd.)

F For any feedbacks/suggestions, please contact 9650749189, email: [email protected]

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