r

GSTIN : 27 AAACA5443N2ZH
In Patient BIii - BIii of S1,1pply Reference No :
Name : Baby Of GAYATRI MADKAI KAR Age: 0Yr 6Mth 21Days
Sex: Male UHID : ANM 1 0000425799

Father Name : BHUSHAN MADKAIKAR

11111111111111111111111111111 Ill IIIDI 11111111111111
,t
Address : 3A-123 KAVERI KALPATARU RIVER SIDE OLD IP N1,1mber: ANMIP65653
PANVEL Navi Mumbai Maharashtra India, Cell
No 91-9833392542 IIHIII IIHI 1111 IIII IIII 111111111111111111111111
Doctor Name : Dr. ASHOK GAWDI AND DR SHRIKANT TIWARI BIii No : ANM-ICS-24360
Speciality : PAEDIATRICS
Ward Name : SEVENTH FLOOR J WARD Date : 17-Mar-2021 Time: 21 :05:05
Bed No : 7044 (SINGLE )
111111111111111111111111111111111111 HI IHI 111111111111111
'i!

Billing Account Type : CASH

Admission Date : 15-Mar-202119:31 :03
j
Discharge Date : 17-Mar;-202119:51 :59

SL. No Service
Amount(INR)
1 Consultation(9993)
13,990.00
2 lnvestigations(9993)
6,970.00
3 Medical Administration(9993)
4 700.00
Medical Services(9993)
4,620.00
5 OT Consumables(9993)
408.80
6 Profi le(999 3)
7
! 580.00
Room Rent(9993)
ff 10,000.00
8 Ward Pharmacy(9993) I; 6,469.50

Service Amount
43 738.00

I
Total Bill Amount (Cash:0.00, NonCash:0.00) = 43,738.00 '
Deposit (2552389) (Cash:0.00, NonCash:75,000.00) 75,00Q.00
Refund (2557469,EFT)
31,262.00
0.00
Net
0.00
• •. :,?.-:::.s.. r. i ':ire-:: 1 i10·, •;J n 1J Se .rt:'< HunrJrnd Tlmt\l'-Ei~ht Only
No Tax is Payable on Reverse Charge Basis

0
Payment Details: Refunded Rupees Thirty-One Thousand Two Hundred Sixty-Two Only to Baby Of GAYATRI
MADKA' i i -

McAmq;,o
Genera te By . Mr. A m r ~·
( hi
PAN NO:AAACA5443N • TAN NO:MUMA49603B • ROH/NI ID :8900080348257 • HOSPITAL REGISTRATION NO:287 '
nnlinn c~.,-AO•• ~-..... "' ·"· AA-
'

Page 1 of 5
,ame: Baby Of GAYATRI MADKAIKAR IP No: ANMIP65653 BIii No : ANM -ICS-24360
SI.No Service Servi ce Name Start Date End Date Dr Name Qty. Amount(INR)
Code ( Order No. )
Consultation(9993) 13,990.00
Consultation 13,990.00
1 10A1 -1~~ ASSESSMENT - TRIAGE Dr. NITIN JAGASIA 1,490.00
(EMERGENCY)
2 1058,:·9 IP VISIT CHARGES (SINGLE) Dr. ASHOK GAWDI 2.500.00 .
AND DR .
SHRIKANTTIWARI
(PAEDIATRICS)
3 1058759 IP VISIT CHARGES (SINGLE) Dr. ASHOK GAWDI 2,500.00
AND DR.
SHRIKANTTIWARI
(PAEDIATRICS)
4 10',c , ~g IP VISIT CHARGES (SINGLE) Dr. ASHOK GAWDI 2.50000 .
AND DR .
SHRIKANT TIWARI
(PAEDIATRICS)
5 1058758 IP VISIT CHARGES (SINGLE) Dr. ASHOK GAWDI 2,500.00
AND DR .
SHRIKANT TIWAR I
(PAEDIATRICS)
1 '.i:-8 7
6 5-9 IP VISIT CHARGES (SINGLE) Dr. ASHOK GAWDI 2,500.00
AND DR .
SHRIKANTTIWARI
(PAEDIATRICS)
lnvestigations(9993) 6,970.00
BioChemistry 1,340.00
1 1G622 BUN (BLOOD UREA NITROGEN) 500.00

2 794 C-REACTIVE PROTEIN (CRP) 580.00

3 232 CREATIN INE - SERUM I PLASMA 260.00

Haematology 1,910.00
4 ~4 BLOOD PARASITES (MALARIA) 740.00

5 <32,- CBC 310.00

6 91 STOOL FOR REDUCING SUBSTANCES 860.00

(871034)
Microbiology 1,8:40.00
7 ~c•· CULTURE AND SENSITIVITY [BLOOD] 1,840.00

Molecular Biology and Cytogenetics 1,700.00

11
8 :<:,9~:, CBNAAT (GEN EXPERT) SARS-CoV-2 1,200.00

9 11 1991:-0 Rapid Antigen SARS CoV 2 500.00

•
Wards Others 180.00
10 :, 4 G9~ ACCUCHECK PERFORMA 180.00

Disclaimer ; 'All the above dates indicated as Date & Time of the entry only Page 2 of 5
rJame : Baby Of GAYATRI MADKAIKAR IP No: ANMIP65653 BIii No : ANM-ICS-24360
Medical Administration(9993) 700.00
Medical Records 700.00
1 ~11~ Medical Records
700.00

Medical Services(9993) 4,620.00

Medical 4,620 .00
1 1077582 Hospital Services and Treatment Monitoring 2.310.00
and Management Charges

2 101758;:> Hospital Services and Treatment Monitoring 2,31000

and Management Charges

OT Consumables(9993) 408.80
Emergency Medical Services 4p8.80
,,
1 1 09e+-0 FACE MASK V4400 N95- VENUS 2 58.80

1 O0fr +O SURGEON GOWN UNSTERILE XL - 2 '

350.00
11 DISPOLINE

Profile(9993) 580.00
BioChemistry 580.00
1 1515c SERUM ELECTROLYTES 580 .00

Room Rent(9993) 10,000.00

Wards Others 10,000.00
1 21~, ROOM RENT(SINGLE) 5,000.00

2 c1:7' ROOM RENT(SINGLE) 5 ,000.00 ·

Ward Pharmacy(9993) 6,469,.50

15-Mar-2021 ,'
3,906.97
1 8 150i COLICAID PAED DROPS 15-Mar-2021 50.00
15ML(HSN 30049099) 23:52.23
(PMIS012604 737)
2 70 17 7 DNS 0 .45% 500ML(B.BRAUN) 15-Mar-2021 115.20
(HSN 30049099) 21:15.47

3 o'.<8 11 EUROFLE X NS 0 .9%W/V 100ML(HSN :3004) 15-Mar-2021 37.73

20:53.50
4 o:,950 EUROFLEX NS 0 .9%WN 500ML(HSN :3004) 15-Mar-202 1 78 .89
2053.50
5 G9G03 INTRAFLOW-AS (ROMSON)(HSN:90183990) 15-Mar-2021
19:53.34
6 5r;s~6 NEOFLAN 26G(HSN:90183930) 15-Mar-2021 4 696.00
19:53.34
7 j1 ~•.:P
NEOFLAN-24G (B .D .)(HSN 90183930) 15-Mar-2021 174 .00
19:53.34
8 '11'.'42 NEOFLAN-24G (B D.)(HSN :90183930) 15-Mar-2021 2 34800
20 :0505
9 5G860 NEOFLON PRO 24G (IV)(HSN 9018) 15-Mar-2021 2 520.00
20 :05.05

Disclaimer : 'All the above dates indicated as Date & Time of the entry only Page 3 of 5
 ANM -ICS-24360
BIii No: 10 1.00
IP No: ANMIP65653 2
Name: Baby Of GAYATRI MADKAIKAR 15-Mar-2021
POSIFLUS H SP · 10ML
/ 10 53629 19:53 34
SYR ENGES (HSN :90183220) 32.50
15-Mar-2021
58790 SCALP VEIN SET· 23G (TOP)(HSN:9018) 120.00
11 20:5350
15-Mar-2021
75'.!1 3 SPLINT PEDIATRIC MEDIUM(HSN :9021 ) 16.00
12 19:53.34 2
15-Mar-2021
.l:'1'2 7 SYRINGES 5ML ROMSON (HSN :90183100) 240.00
13 19:53.34 30
15-Mar-2021
14 B4c<58 VECTRA LEAN P/F LATEX GLOVES -M
19:53.34
100S(VECTRA LEAN ) 578.00
2
15-Mar-2021
15 6045 1 VEIN-O-LINE 10CM(HSN:90189099) 390.00
19:53.34 2
15-Mar-2021
16 ,881 1 VELFI X IV CANNULAZIATION
19:53 34
ORESSl (HSN :48211010) 8765
15-Mar-2021
17 :04693 Z INCONIA 100ML SYP(HSN 30045020)
2352.23
(PMIS01 2604 737) 2,130.03
16-Mar-2021 40.32
16-Mar-2021
1 3130T CALPOL 250MGi 60ML ORAL
3:30 11
SUSPENSION(HSN :30049069) 120.00
2
(PM1S012604912) 16-Mar-2021
2 12!:-6 DC UNDER PAD 60X90CM
19:50.45
#(HSN:48189000) 230.40 .
2
(P M!S01 2607099) 16-Mar-2021
3 101,·, DNS 0.45% 500ML(B BRAUN )
3:06.44
(HSN :30049099) 2610
2
(PMIS012604956) 16-Mar-2021
4 32~:::' EMESET 4MG2ML INJ(HSN:30049035)
3:06.44 13.05
(PMIS01 2604956)
16-Mar-2021
32922 EMESET 4MG2ML INJ(HSN :30049035)
5 23:02 .04 26.10
2
(PMIS012607658) 16-Mar-2021
:·t?9::!2 EMESET 4MG2ML INJ(HSN 30049035)
6 23:02 04 5444
(PMIS012607658)
16-Mar-2021
ENTEROGERMINA 5ML(HSN :30029030)
7 510'.·fi 3:06.44 54.44
(PM IS01 2604956 ) 16-Mar-2021
ENTEROGERMINA 5 ML(HSN 30029030 ) :
8 ~) 1 lfj{j 3:0658 54.44
(PMI S012604953)
16-Mar-2021
51050 ENTEROGERMINA 5ML(HSN 30029030)
9 23:0204 25000
(PMIS012607658)
16-Mar-2021
83458 MICROTIZE-1 HAND DIS 500ML(HSN :3004)
10 1 :26.25 49.70
(P MIS01 2604870)
16-Mar-2021
11 64102 PANSEC IV 40MG(HSN 30049039)
3:0644 49.70
(PM1 S012604956)
16-Mar-2021
12 641 0"' PANSEC IV 40MG(HSN 30049039)
23:02.04 235.00
(PMIS012607658J
16-Mar-2021
108 PEDI A DRIP SET (ROMSON )( HSN 9018)
13 1:26.25
(PM IS012604870 )

Page 4 of 5
Disclaimer : ·All the abov e dates indicated as Date & Time of the entry only
 I

ANM-ICS-24360
,~!.;.•sfs~pe)SIFUJSi:isi;-:-~if:...:.:..::_
Baby Of GAYATRI MADKAIKAR
_ ___ _ _J~~-d~~~~------..!!~!£.:_!_~~~~~---=-,-::'.~I
IP No: ANMIP65653 BIii No:
3 151 .50

(i
, 53829 POSIFLUSH SP - 10ML 16-Mar-202 1
1
SYRENGES(HSN 90183220) 1 :26.25
(PMIS012604870) 17.66
1
15 3,•G5~ SODIUM CHLORIDE 9% 100ML (NIRLIFE) 16-Mar-2021
(HSN 30045020) 3:06.44
(PMIS012604956) 17.66
1
16 396:·2 SODIUM CHLORIDE 9% 100ML (NIRLIFE) 16-Mar-2021
(HSN :30045020) 23:02.04
(PMIS012607658) 4 52 .00
17 GOc1 o SYRINGE WITH NEEDLE 10ML ( ROMSONS) 16-Mar-2021
(HSN 9018) 1:26.25
(PMIS012604870J 3 19.50
18 4 0T2, SYRINGES 2ML (ROMSON)(HSN :90183100) 16-Mar-2021

(PMIS012604870) 1:2625 44.92

2
19 40,;:,,, 16-Mar-2021
TAXIM 500 MG INJ(HSN :30042019)
3:06.44 43.10
(PMIS0l 2604956) 2
16-Mar-2021
20 4093,, TAXIM 500 MG INJ(HSN :30042019)
23:02.04 290.00
(PMIS012607658) 2
16-Mar-2021
21 60685 UNDERPAD MATTY PRO
1:26.25
ROMSON(HSN48182000)
2 290.00
(PMIS012604870)
16-Mar-2021
22 00(>05 UNDERPAD MATTY PRO
8:46.04
ROMSON (HSN :48182000)
(PMIS012605499)
432.50
17 -Mar-2021
4 2600
17-Mar-2021
1 4 0723 SYRINGES 2ML (ROMSON)(HSN:90183100)
2:01.04 28.00
(PM1S012608087) 2
2 4 '. '1'.! 3 SYRINGES 5ML BD.(HSN :90183100)
17-Mar-2021 '
2:01 .04 290.00
(PMIS01 2608087) 2
17-Mar-2021
3 :lOfii<c UNDERPAD MATTY PRO
343.25
ROMSON (HSN :481 82000)
1 88.50
(PM1S01 2608047)
17-Mar-2021
4 5.' tn Z& D SYP 20 0S15ML
19:5134
SYRUP(HSN :30049039)
(PMIS012610311) 43,738.30
((1) 1nd1cates. bed:>1de Grand Total
;§1 md1r.ates stat !"..er: ice
E) 1nd,cates dead pat~ent_
Ru pees Forty-Three Thousand Seven Hundred Thirty-Eight Only
Bed Details Bed No Bed Category
To Date Duration
SI.No From Date 7044 SINGLE
16-Mar-2021 7 31 pm 24 00
1 15-Mar-2021 7 31 pm
7044 SINGLE
17-Mar-2021 7:31 pm 24.00
2 16-Mar-2021 731 pm

Profile Breakup
Department Name
S.No Service Name
• . ''<
1 SERUM ELECTROLYTES BioChemistry
1 CARBON OIOXIDE(CO2), TOTAL- SERUM/ PLASMA
BioChemistry
2 CHLORIDE - SERUM / PLASMA
BioChemistry
3 POTASS IUM . SERUM i PLASMA
BioChernistry
4 SODIU M - SERUM i PLASMA

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