(CHRISTIAN MEDICAL COLLEGE VELLORE.
RANIPET CAMPUS.
AN
KILMINAL VILLAGE, RANTES RATERAiscHARGE BILL\\\ Ema 1s
[email protected]
, INVOICE-CUM-BILL OF SUPPLY\ ‘
[email protected]
ivorck NUP BI3251-02/2024 ATCI278NIZN
Hosp.No :452625D . Bill No
Name :SUBRAMANI G. Clinic (ARY MEDICINE
IPNo, :24R004094 Ward
CASH DETAILS PAID:
0510224 CASH ADV.(T6198R053644) 400000:00
0510224 CASH WEEK.(52768R364928)
BATE BA RTICUTARS RS TAL DISCOUNT TAXABLE FAK ANGUNT
AMOUNT, AMOUNT AMOUNT TO PAY
GSUORAT BATT RECITATION GENERAL WA GS ‘0 iio BN SISO
03/0224. 12118:1CU FREE WORK 0.00 3775.00 0.00 0.00 3775.00)
03/02/28 12000-ICU BED CHARGES(RMI3) 10605.00 0.00 0.00 0.00 10605.00
03/02/24 12107-LC.U. MONITOR PER DAY 2255.00 0.00 0.00 0.00 2255.00
03/02/24 XVOIS-ICU-PROFESSIONAL CHARGES 2000.00 0.00 0.00 0.00 2000.00
03/02/28 X¥019-Prof CHARGES PMEDDays:! 1000.00 0.00 0.00 0.00 1000.00
03/02/24 12114-ARTERIAL BLOOD GAS - MIC 685.00 0.00 0.00 0.00 685.00
03/0224. 12144-VIDEO LARYNGOSCOPE 2140.00 0.00 0.00 0.00 2140.00
03/02/24. 12139-TOTAL FULL FACE MASK (NI 2300.00 0.00 0.00 0.00 2300.00
03/02/24 03225-PROCALCITONIN 1360.00 0.00 0.00 0.00 1560.00
(03/02/24 03108-MAGNESIUM 645.00 0.00 0.00 0.00 645.00
03/02/24 03018-PHOSPHORUS 195.00 0.00 0.00 6.00 195.00
03/02/24 03249-TROPONIN T 1080.00 0.00 0.00 0.00 1080.00
03/02/28 032S0-CKMB MASS 645.00 0.00 0.00 00 645.00
03/02/24 03230-NT- pro BNP 2345.00 0.00 0.00 000 2345.00
03/02/24 12149.3(0 ETHILON CHARGES, 300.00 0.00 0.00 0.00 300.00
03/02/24 03334-X-RAY PORTABLE (ADULT)-1 718.00, 0.00 0.00 000 715.00
(03/02/24 12114-ARTERIAL BLOOD GAS - MIC 685.00 0.00 0.00 0.00 685.00
(03/02/24 01144-URINALYSIS ROUTINE 290.00, 0.00 0.00 0.00 290.00
03/0/24 04170.CiS BLOOD COMMON 2145.00 0.00 0.00 0.00 2145.00
03/02/24 04170-C/S BLOOD COMMON 2145.00 0.00 0.00 000 2145.00
(0802/24 [2114-ARTERIAL BLOOD GAS = MIC 1685.00 0.00 0.00 0.00 685.00
(04/02/24 07072-PCR FOR MULTIPLE VIRUSES 6075.00 0.00 0.00 0.00 6075.00
(05102724 07107-QUALITATIVE PCR FOR SARS 1055.00 0.00 0.00 0.00 1055.00
(04/02/24 04166-C/S SPUTUM COMMON 1795.0 0.00 0.00 000 1795.00
(0402724 3F090-GRBS 660.00, 0.00 0.00 0.00 660.00
O¥OU24 12121-VENTILATOR-DAY | CHARGE 3265.00 0.00 0.00 0.00 3265.00
(0402/24 35002-OXYGEN(HR:21 MIN: LTR:S 2362.50 0.00 0.00 0.00 2362.50,
04/0224 35008-OXYGEN SUBSIDY 0.00 23625 0.00 000 236.25(
0402724 12114-A1LTERIAL BLOOD GAS - MIC 685.00 0.00 0.00 000 685.00
04/0224. 12118:ICU FREE WORK 0.00 3775.00 0.00 0.00 3775.00)
(04/02/24 12000-ICU BED CHARGES(RMI) 1605.00 0.00 0.00 0.00 10605.00
(04/02/24 12107-1,C.U, MONITOR PER DAY 2255.00 0.00 0.00 0.00 2255.00
0402724 XYOIH-ICU-PROFESSIONAL CHAR 2000.00 0.00 0.00 0.00 2000.00
080224 XYO19-Prof CHARGES PMEDD: 1000.00 0.00 0.00 0.00 1000.00
sue yey ram RR ranch SO THT TT oi,
il pb li Wasicn SondClksdiwanteies Colee BEBAN Assoc 00 0.001 disputes BAODsubjecte2M%O0e
se ih Acgount Nar 41 180710426 jurisdiction of Vellore courts onl:
SHINO6060 (Ocdentes umber Z20)
io) vino Ot pal nnd afer e Continues.
TORN RPTTACC SOD OOTAVOTARIOEE
Scanned with CamScanner —
‘Telephone No : 04172 ~ 224096
CHRISTIAN MEDICAL COLLEE
RANIPET CAMPUS
KILMINAL VILLAGE, RANIPET DISTRICT
TAMIL NADU, INDIA
giNeeaa? IN-PATIENT DISCHARGE BILL
VELLORE
Email 1D: in
in
Page No. :2
uNT
AMOUNT AMOUNT TO PAY
OW0224 | SFOGO.IND, VERFEN SOMCG/IML, | 20900 0.00 000 000 239.00
0402724. 3FOG0.INI, VERFEN SOMCG/IML, 239.00 000 000 090 239.00
0022 RIL4ARTERIAL RLOOD GAS - MC ssso0 0000000000
owon2s 33000-0187 PATIENT) 9500 0000000080
won/24 RI14-ARTERIAL BLOOD GAS - MIC 650000008500
05/02/24 01002-HAEMOGLOBIN: 90.00 0.00 0,00 0.00 90.00
S024 o100S.PL.ATELET COUNT 13590 000 m0 3500
osoaa¢_aloo7.wne TOTAL 12500 ago aga 8.00
224 ojo2s-pr-wirttINR 44000 0000000004000
05/02/24 01103-APTT 630.00 0.00 0.00 0.00 630.00
080224 0315S-UREAICREATININE 33500 000000000335 00
05/02/24 03269-Na/K STAT (HEPARIN) 400.00 0.00 0.00 0.00 400.00
05/02/24 03108-MAGNESIUM 645.00 0.00 0.00 0.00 645.00
050224 02016-URIC ACID 2700 0900000200
050224 12114-ARTERIAL BLOOD GAS - MIC s00 000 == 000g (5.00
002724, 35003-COMPRESSED AIR a
05/02/24 12122-VENTILATOR-SUBSEQUENT DA 1328.00 0.00 0.00 0.00 1325.00
osioa24_35002-0XYGENGHRG24 MIN: LTR:S 270000 000-000 aco 20000
0sioa24_35008.0XYGEN SUBSIDY 000 27900 ooo. 7000¢)
0802724 3FO50-IND. VERFEN SOMCGVIML, 1 47800 00000000
| osinz24 3F060-INJ. VERFEN SOMCG/IML, 1 478.00 0.00 0.00 0.00 478.00
05/02/24 3F060-INJ. VERFEN SOMCG/IML, | 478.00 0.00 0.00 0,00 478.00
05/02/24 33000-DIET (PATIENT) 285.00 0.00 0.00 0.00 285.00
05/0224 12000-ICU BED CHARGES(RMI3) 10605.00 0.00 0.00 0.00 10605.00
05/02/24 12107-1.C.U, MONITOR PER DAY 2255.00 0.00 0.00 0.00 2255.00
05/02/24 XYO14-ICU-PROFESSIONAL CHARGES 2000.00 0.00 0.00 0.00 2000.00
05/02/24 XY019-ProfCHARGES PMEDDays:1 1000.00 0.00 0.00 0.00 1000.00
05/02/24 05334-X-RAY PORTABLE (ADULT)-1 715.00 0.00 0.00, 0.00 715.00
05/02/24 12114-ARTERIAL BLOOD GAS - MIC 685.00 0.00 0.00 0.00 685.00
05/02/24 04107-RIF XPERT TB PCR 2375.00 0,00, 0.00 0.00 2375.00
osioa4 121 MeARTERIAL HOOD GAS - MIC sasoo 00000000
06/02/24 121 14-ARTERIAL BLOOD GAS - MIC. 685.00, 0.00 0,00 0.00 685.00
: 19500
eee a EEO tion” gues ancenjectl he
* Account No AL ESU TL O426, jurisdiction of Vellore courts only:
Irn esa tip an ae at a
TORRTRPTIACE SEIT GOT ORH
Scanned with CamScanner CHRISTIAN MEDICAL COLLEGE VELLORE.
‘Telephone No: 2
RANIPET CAMPUS. phone No 04172 224096
KILMINAL VILLAGE, RANIPET DISTRICT Email 1D: in
‘TAMIL NADU, INDIA in
PIN 632.517 IN-PATIENT DISCHARGE BILL. Page No, :3
BB No.: K24050761
Clinic, : PULMONARY MEDICINE
Ward 3202
TOTAL DISCOUNT FARBER ONE
AMOUNT. AMOUNT,
BARTICULARS
35002-ONYGEN(HR:24 MIN: LTR:S 2700.00, 0.00 00 2700.00
(008-ONYGEN SUBSIDY 0.00 270.00 0.00 0.00 270.00.)
3F090-GRAS 720.00 0.00 0.00 0.00 720.00
3F060-INJ. VERFEN SOMCG/IML, 1 239.00 0.00 0.00 0.00 239.00
33000.DIET (PATIENT) 367.00 0.00 0.00 0.00 367.00
I2N18.CU FREE WORK, 0.00 3775.00 0.00 0.00 3775.00.)
12000-1CU BED CHARGES(RMI3) 1060.00 0.00 0.00 0.00 10605.00
12107-L.C.U. MONITOR PER DAY 2255.00 0.00 0.00 0.00 2255.00
NYOIS-ICU-PROFESSIONAL CHARGES: 2000.00, 0.00 0.00 0.00 2000.00
XYO19-Prof CHARGES PMEDDay 1000.00 0.00 0.00 0.00 1000.00
12114-ARTERIAL BLOOD GAS - MIC 685.00 0.00 0.00 0.00 685.00
12114-ARTERIAL BLOOD GAS - MIC 685,00 0.00 0.00 0.00 685.00
12139-TOTAL FULL FACE MASK (NI 2300.00 9.00 0.00 0.00 2300.00
12114-ARTERIAL BLOOD GaS - MIC 685.00 0.00 0.00 0.00 685.00
12141-PROBE COVER, 40.00 (0.00 0.00 0.00 40.00
0710224. 12135-NASAL PRONGS 40.00 0.00 0.00 0.00 40.00
07/02/24 03267-POTASSIUM STAT (HEPARIN) 198.00 0.00 0.00 0.00 195,00
33000-DIET (PATIENT) 396.00 0.00 0.00 0.00 396.00
07/02/24 1211 8ICU FREE WORK 0.00 3775.00 0.00 0.00 3775.00(-)
07/0224 12000-ICU BED CHARGES(RMI3) 10605.00 0.00 0.00 0.00. 10605.00
0702/24 12107-L.C.U, MONITOR PER DAY. 2255.00 0.00 0.00 0.00 255.00
0702/24 XYOI8-ICU-PROFESSIONAL CHARGES. 2000.00 0.00 0.00 0,00 2000.00
O7Y2_ XYO1-ProfCHARGES PMEDDays:1 1000.00 00 0.00 0.00 1000.00
07/02/24 0$74%-OUTSIDE X-RAY FILM SCANN. 515.00 0.00 0.00 0.00 515.00
07/0224 3FO90-GRBS 720.00 0.00 0.00 0.00 720.00
07/0224 35003-COMPRESSED AIR 190.00 0.00 0.00 0.00 190,00
u7/02/24 35002-ONYGENCHR:23 MIN: LTR:7 3622.50 0.00 0.00 0.00 3622.50
090224 3$00%-OXYGEN SUBSIDY 0.00 362.25 0.00 0.00 362.25(-)
70Y24 96069-ECHO - ADULT - CARDIOLOG 2485.00 0.00 0.00 0.00 2485.00
(70224 440K0-ARTERIAL BLOOD GAS (RMED. 685.00 0.00 0.00 0.00 685.00
070224 3$002-OXYGENIIR:10 MIN: LTR:2 450.00 0.00 0.00 0.00 450.00
UTOYIA 350U%OXYGEN SUBSIDY 0.00 45.00 0.00 0.00 45.00()
70224 370H0-GRBS 300.00 0.00 0.00 0.00 300,00
(0710224 3¥053-MONITORING CHARGES (L3) 135.00 0.00 0.00 0.00 135,00
HRA O5-X-RAY CHEST ADULT-L 340 00 0.00 0.00 0.00 380.00
OHM 3$002-OXYGENINK A MIN. LTR2 ) 180.00 0.00 0.00 0.00 180,00
ORO 340K OXYGEN SUBSIDY. 0.00 1800 0.00 0.00 18.00(-)
ONDA W3I7AIBAL C (GLYCOSYLATED 1b) 00.00 0.00 0.00 0.00 600.00
on _UUS2-I8H 100.00 0.00 0.00) 0.00____700.00
DRO
rich 000 000 0.00 1000.00
“All disputes ary subjected to the
Jurisdiction of Vellore gourts ont
TUL
eye Vellne Assoc
Nott Ot hOdd
HSC Cae: Si} oa6 4060 (D denotes nu
TORATTPTTAC SOOT TOT RET
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08/02/24
8/0228
98/02/24
08/02/24
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9102/24
9102/24
09/02/24
09/02/24
9/02/24
9102/28
ovi02/a
9102/24
roiores
RANIPET CAMPUS
‘TAMIL NADU, INDIA
PIN 632 517
(03134-CALCIUM AND PHOSPHATE
OB1S4.NAK
44080-ARTERIAL BLOOD GAS (RMED
3F0S3-MONITORING CHARGES (3)
‘XX001-IDays-GENERAL-BED NURSIN
‘XX004-IDays-GEN FREE WORK
XYO01-PMED:2Days-PROF CHARGES
(03179-URINARY SPOT MICROALBUMI
81005-DIABETES EDUCATION (1)
XY053-CARDI CONSULTATION (ONLI
3F0S3- MONITORING CHARGES (L3)
‘XX001-1Days-GENERAL-BED NURSIN
‘XX004-1Days-GEN FREE WORK
XY001-PMED:1Days-PROF CHARGES
XY001-PMED - PROFESSIONAL FEE
3F090-GRBS-7
30048-RUPEE ADJUSTMENT - DIS.B.
CHRISTIAN MEDICAL COLLEGE VELLORE
KILMINAL VILLAGE, RANIPET DISTRICT
IN-PATIENT DISCHARGE BILL,
365.00 0,00
400.00 0.00
685.00 0.00
135.00 0.00
1510.00 0.00
0.00 300.00
3420.00 0.00
475.00 0.00
285.00 0.00
820.00 0.00
135.00 0.00
1510.00 0.00
0.00 300.00
1710.00 0.00
0,00 1710.00
420.00 0.00
1.00 0.00
art 04172 -224096
A
Page No.
0.00 0.00 365.00
0.00 0.00 400.00
0.00 0.00 685.00
0.00 0.00 135.00
0.00 0.00 1510.00
0.00 0.00 300,00(-)
0.00 0.00 3420.00
0.00 000 = 475.00
0.00 0.00 285,00
0.00 0.00 820.00
0.00 0.00 135.00
0.00 0.00 1510.00
0.00 0.00 300,00(-)
0.00 0.00 1710.00,
0.00 0.00 1710.00(-)
0.00 0.00 420.00
0.00 0.00 1.00
0.00
147365.50
wivieine . te cers
07/0224 MEZOLAM IN} SMGML (NEON bin 609 0.00 000 115.020)
Qr¥s10 TCODF: 2101 :
07/02/24 LASIX-INJECTION,10mg/Im! 13.39, 0.00 0.00 0.00 13.3%(-)
QT¥:1 TCODE: 11453
0702/24. PRESSURE MONITORING LINE 38400000 000 000384004)
@rv2Tcove: 901
07/2124. DISP SYRINGE PLASTIPAK LU 7500000 000.00 —778.006)
Qrv's TCODE: 14780
0710224. SODIUM CHLORIDE 0.9% (FRE 19694 000 000 0.00 196.94)
QTY:2 TCODE: 10639
070224 POTPHOS.INJECTION.A6% wv mst 488 ooo 000 92.630)
‘ary.1 TcoDE: 10760
07/02/24 DISP.NEEDLE- 18G -1.5 INC 9.00 0.00 0.00 0.00 9.00(-)
QTY:3 TCODE: 7500
orwans L-INJECTION,S0m ss 33s 000 000487)
arya cope: 14183
(70224 PANTOCID-NJECTION, 40 mg soso 565 000 000——s085¢)
QTY:1 TCODE: 13647
0710224. POTAHTN.-CL-INJECTION 50m 3801338 000 000120424)
edie ens RRR Roncned93 0.98) disputes BBAubjecrAPEAL
INGN64060 (Oalenotes number zero)
UI pl mane si min at
Jurisdiction of Vellore courts only.
Continues.
FORRURFTACC-SOE OO UT ORIORT
Scanned with CamScanner CHRISTIAN MEDICAL COLLEGE VELLORE
RANIPET CAMPUS,
KILMINAL VILLAGE, RANIPET DISTRICT
‘TAMIL NADU, INDIA
PIN 632 517 IN-PATIENT DISCHARGE BILL.
‘Telephone No : 04172 - 224096
HH
Page No.5,
Clinic. : PULMONARY MEDICINE,
NT
Topay
QTY: TCODE: 3475
(07/0224 MEZOLAM INI SMG/ML (NEON 124.71 6.09 0.00 000 115.6),
QTYs0 TCODE: 2101
(07102724 LASIX-INJECTION,0mgitm! 26.78 0.00 0.00 0.00 26.18)
QTY:2 TCODE: 11453
0710224 NEOVEC-10-INJECTION, 10m 491.00 0.00 0.00 0.00 491,00(-)
QTY:4 TCODE: 4831
07/02/24 ALPHADEX-INJECTION,100ue/ 1954.00 195.40 0.00 0.00 1758.60.)
QTY:2 TCODE: 13560
07/02/24 H-CORT-INJECTION, 100 mg. 41.50 415 0.00 0.00 3735)
QLV:1 TCODE: 9711
0702/24 THIALIN-INJECTION,100mg/1 101.20 10.12 0.00 0.00 91.08(-)
QTY:4 TCODE: 14199
1010224 EMSTAR-INJECTION, | gm. 2959.51 739.88 0.00 0.00 2219.63(
QTY TcopE: 10398
1010224 DISP.SYRINGE & NEEDLE-10 13600 20.40 0.00 0.00 115.60(-)
QTY4 TCODE: 808
10/02/24 DISP.SYRINGE & NEEDLE-S M ‘n.00 120 0.00 0.00 64.80(-)
QTY4TCODE: 5807
10/02/24 CLEXANE-60-INJECTION,60mg 1422.02 142.20 0.00 0.00 1279.82)
QTY:2 TCODE: 6260
1010224 SODIUM CHLORIDE 0.9% (DEN 73.20 0.00 0.00 0.00 73.20)
QTY3 TCODE: 5559
1010224 DISPOSABLE BED UNDERPAD - 90.00 0.00 0.00 0.00 90.00(-)
QTY:1 TCODE: 11798
10(02/24 SUCTION CATHETER - 14 (TO 118,00 11.80 0.00 0.00 106.20)
Qry2TCoDE: 3780
1010224 DISP.SYRINGE & NEEDLE-2M 28.00 2.80 0.00 0.00 25.20(-)
QTY2TCODE: 806
10/0224 POTAIIIN-CLeINJECTION, 150m 53.52 535 0.00 0.00 48.170)
QTY:2 TCODE: 14183,
1010224 INSYTE- 20,206 | NUMBER 73950 718s 0.00 0.00 167.65(-)
QTY:I TCODE: 1024
10/0224 DISP.SYRINGE & NEEDLE-S M 54.00 5.40 0.00 0.00 48.60)
QTY3 TCODE: 807
1010224 DISP.SYRINGE & NEEDLE-2M 56.00 3.60 0.00 0.00 50.40(-)
QTYATCODE: 06
100224 DISP SYRINGE & NEEDLE-10 170.00 25.80 0.00 0.00 144,50)
QTYSTCODE: 08
stom SYN ick NATE Mot, Kannan, AR Haney 0.00) 0.00 81.00)
ak n Maia Colle Vellore Asection AN disputes are subjected (0 the
{0064060 (denotes nue zero) Jurisdiction of Vellore gout ca
mao eset uth UTR Tapa mami ater malig ant
TORRE TACT SOTO OTROS
Scanned with CamScanner (CHRISTIAN MEDICAL COLLEGE VELLORE é
RANIPET CAMPUS: Teeptione a: att
KILMINAL VILLAGE, RANIPET DISTRICT mat |
TANI NADL INDIA ie:
PiNetist7
INPATIENT DISCHARGE MILL i
For The Period From: 03/02/2024 11:16 To: 10/02/2024 06:45 Fae Ni
Bill No : K24050761
Clinic, : PULMONARY MEDICINE
Hosp.No :452625D
(OUNT
QTY:s TCODE: 807
100224 A-LINE BLOOD GAS SYRINGE- 119.00 41.65 0.00 0.00 7235(-)
QTY:1 TCODE: 7056
1010224 CLEXANE-60-INJECTION,60mg Mol 71.10 0.00 0.00 639.91¢)
QTY:1 TCODE: 6260
1010224 SODIUM CHLORIDE 0.9% (DEN 32.90 0.00 0.00 0.00 32.90(-)
QTY:1 TCODE: $531
1010224 DISP.NEEDLE:26G (NIPRO),2 30.00 0.00 0.00 0.00 30.00(-)
QTY:10TCODE: 805
1002/24 LUER CAP, | NUMBER 33.00 0.00 0.00 0.00 33.00)
QTY:3 TCODE: 12688
10/0224 NS-FFS [RUSOMA]-INJECTION 39.04 0.00 0.00 0.00 39.04¢)
QTY:1 TCODE: 14257
FUND CONCESSION:
Pharmacy Returns 1133352" 1433.97 ‘00 o.00""""9R09.75
194.56
-11333.52,-1433.77 0.00 0.00 -9705.19
Pharmacy Summary
Total Dispensary 0.00
()Drug Retums 9899.75
(4)Service Charges[Pharmacy]: 194.56
00013766031
‘Balance wo be refunded
In Figures :Rs. -12340/-
In Words :Rs, Twelve Thousands Three Hundreds and For
Continues.
vn Ae sion Al dlspes ar subjected to the
justeton of Vole courts on
SEINOO6-4060 (O-denotes | srumber. rei) - ” is
TORT TACT VOT OTTIBIDEE
Scanned with CamScanner
