Patient's Invoice

INVOICE #5669626


 Elite Hospital

E 104, Dharti-2,
Nr' Viswakarma Temple,
Talaja Road,
Bhavnagar - 364002

To,

Richard Nixon

E 104, Dharti-2,
Nr' Viswakarma Temple,
Talaja Road,
Bhavnagar - 364002

Invoice Date : 23rd Jan 2017

Due Date : 25th Jan 2017

# Item Name Quantity Charges Total
1 Visiting Charges - $100 $100
2 Medicines 10 $100 $1000
3 X-ray Reports 2 $600 $1200
4 Other Charges - - $300

Sub - Total amount: $1600

vat (10%) : $160


Total : $1760


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