INVOICE
Patient Info:
Jordon Smith
Phone: +1 562 563 8899
Bad No: G5
Invoice No:
#DI56789
Invoice Date:
15/12/2024
| Patient ID | Age | Admit Date | Insurance |
|---|---|---|---|
| 45123 | 35 Years | 30/11/2022 | Yes |
| S No. | Description | Price | Amount |
|---|---|---|---|
| 1 | All Blood Test | $200.00 | $200.00 |
| 2 | Sugar Test | $40.00 | $40.00 |
| 3 | Surgeon Fee | $60.00 | $60.00 |
| 4 | Medical Medicine Bill | $125.00 | $125.00 |
| 5 | Hospital Usage Bill | $80.00 | $80.00 |
Hospital Rules:
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| Sub Total: | $505.00 |
| Tax (18%) | $90.90 |
| Grand Total: | $595.90 |
Note: