Services Detail Bill E96269
Bill Number 5669 Bill Date / Discharge Date 30-04-2019 2:32PM /
IP Number E96269 Reg Number 1501764
Admission Date 30-04-2019 8:46AM Physician Dr.BHARATH RANGARAJAN
Ward 4TH NORTH SOUTH WING B Bed No 4043
Patient Type CORPORATE Source Name MEDI ASSIST - REF.NO : 0
Case Type ONCOLOGY
Patient Name Mr.MOHAN RAJU
Age / Sex 52 Years / M
Address H/O SAVITHIRI
224/2C PALLADAM MAIN ROAD
CHETTIPALAYAM
COIMBATORE 641201
Contact No 7904425962
Header Date Service Qty Amount
PHARMACY
TNGST.NO: 10ML SYRINGE WITH NEEDLE. .. . . Batch No 1810510 /
30/04/2019 1.00 22.00
33212224283 Sep`23/Inv No:82313
DL.NO :CBE/2387/20,21
2ML SYRINGE WITH NEEDLE .. . . Batch No 9036800 / Jan`24/Inv
30/04/2019 2.00 20.00
No:82313
50ML SYRINGE LUER LOCK .. . . Batch No 8360520 / Dec`23/Inv
30/04/2019 1.00 78.00
No:82313
5ML SYRINGE WITH NEEDLE .. . . Batch No 8344679 / Nov`23/Inv
30/04/2019 1.00 13.00
No:82313
DECDAN INJECTION 2 ML Batch No 37R0088 / Apr`20/Inv
30/04/2019 1.00 5.97
No:82313
EASY SEAL MEDIUM SINGLE . . Batch No 18028 / Sep`21/Inv
30/04/2019 2.00 8.00
No:82313
ECOFLAC MIX DEVICE . . Batch No C0682018 / Mar`21/Inv
30/04/2019 1.00 52.00
No:82313
ECOFLAC PLUS NS IV FLUID 500 ML Batch No B19A086E /
30/04/2019 1.00 74.26
Dec`21/Inv No:82313
GEMCITE INJECTION 200 MG Batch No 186349G / Feb`21/Inv
30/04/2019 3.00 3693.00
No:82313
30/04/2019 GEMCITE VIAL 1 GM Batch No C760160A / Apr`20/Inv No:82313 1.00 5576.00
INSTANTINO INJECTION 5 ML Batch No 1810007A / Sep`20/Inv
30/04/2019 1.00 168.00
No:82313
INTRAFIX SAFE SET .. . . Batch No E09K8122 / May`23/Inv
30/04/2019 1.00 244.00
No:82313
KEMOPLAT 10 ML/ INJECTION 10 MG Batch No NN8318C /
30/04/2019 4.00 289.40
Jun`20/Inv No:82313
MAGNESIUM SULPHATE 50% INJECTION . . Batch No 5288 /
30/04/2019 1.00 11.10
Sep`21/Inv No:82313
MINI SPIKE DEVICE . . Batch No L02AB131 / Oct`22/Inv
30/04/2019 1.00 136.00
No:82313
30/04/2019 NEEDLE 18 X SIZE 11/2 . Batch No 04941 / Dec`23/Inv No:82313 2.00 5.00
NS UNIBAG IV FLUID 250 ML Batch No 1187670 / Nov`21/Inv
30/04/2019 1.00 49.21
No:82313
NS UNIBAG IV FLUID 500 ML Batch No 2190396 / Dec`21/Inv
30/04/2019 2.00 148.52
No:82313
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Page Cont >>
Services Detail Bill E96269
Bill Number 5669 IP Number E96269 Patient Name Mr.MOHAN RAJU
Header Date Service Qty Amount
PHARMACY
TNGST.NO:
30/04/2019 OLEANZ TABLET 5 MG Batch No EMT2627 / Sep`21/Inv No:82313 1.00 3.68
33212224283
DL.NO :CBE/2387/20,21
POTASSIUM CHLORIDE INJECTION 10 ML Batch No 5325 /
30/04/2019 1.00 24.60
Nov`21/Inv No:82313
NS UNIBAG IV FLUID 1000 ML Batch No 2190286 / Dec`21/Inv
30/04/2019 1.00 83.17
No:82747
CONNECTA PLUS 3WH-10CM.395095 SINGLE . . Batch No
30/04/2019 1.00 159.00
8152941 / May`21/Inv No:82825
POSIFLUSH SP P F SYRINGE 10 ML Batch No 8319564 /
30/04/2019 3.00 126.00
Oct`21/Inv No:82825
VENFLON PRO SAFETY SINGLE 22 GU Batch No 8299671 /
30/04/2019 1.00 332.00
Oct`21/Inv No:82825
Sub Total 11,321.91
DOCTOR FEES 30/04/2019 BHARATH RANGARAJAN DOCTOR FEES 1.00 2000.00
Sub Total 2,000.00
ROOM CHARGE 30/04/2019 C+ SINGLE ROOM 1.00 1600.00
Sub Total 1,600.00
NURSING CHARGES 30/04/2019 C+ SINGLE NURSING CHARGE 1.00 850.00
Sub Total 850.00
CYTOTOXIC DRUG
30/04/2019 GEMCIS 1.00 340.00
PREPARATION CHARGES
Sub Total 340.00
DIETARY 30/04/2019 NO SUGAR ORANGE JUICE 1.00 45.00
30/04/2019 NO SUGAR POMOGRANATE JUICE 1.00 85.00
Sub Total 130.00
SURG.DISPO.MATERIALS 30/04/2019 TEGADERM 7CM X 8.5CM (1633) NOS / 3M/Inv No:35438 1.00 123.00
Sub Total 123.00
REGISTRATION CHARGE 30/04/2019 IP REGISTRATION FEES 1.00 50.00
Sub Total 50.00
DISCHARGE SUMMARY 30/04/2019 DISCHARGE SUMMARY 1.00 20.00
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Services Detail Bill E96269
Bill Number 5669 IP Number E96269 Patient Name Mr.MOHAN RAJU
Header Date Service Qty Amount
Sub Total 20.00
Round Off 30/04/2019 IP Bill Round Off 1.00 0.09
Sub Total 0.09
Page 3
Bill Total 16,435.00
Bill Prepared By : RENUIP51 / 30-04-2019 14:32:46 - Printed By : RAJESWARI06 For KMCH Hospital
Authorized Signatory
