UPI Scan & Pay

Fortis
Fortis Hospital
Sector 62, Phase-VIll
Mohali 160 062
Tel.: 91-172-469-2222, 91-172-502-1222
HOSPITAL OUTPATIENT BILL Fax: 91-172-4692221, 91-172-509-6221
E-mail: contactus.mohali@fortishealthcare.com
Mohali GST No.:03AAACFO987E1ZZ Website: www.fortishealthcare.com

1002230PCSso37019
Mrs. Damodri Devi Bill No
Name CASH
Bill Type
UHID 6389422
03-Feb-2023 9:12 AM
Bill Date
EpisodeNo 28055/23/1002
03-Feb-2023 9:12 AM
Print Date
Age/Sex 49 YEAR(S)/Female
Discount Scheme NA
Primary Doctor Rajan Chugh
:L85110P81996PLCO45933
CINNo.
Contact No. 8427672730o CHANDIGARH
Payor Site Name
Payor Name
POWER GRID CORPORATION OF
INDIA LIMITED
old UHID : 145084M
Ref Doctor :Direct Walk in
Employer Name NA
Insurance NA
ZIRAKPUR TPA Name
Patient Address 539, deshmesh colony, zirakpur Baltana
140603 Punjab India

Amount Contractual Net Gross Amount

Accession No HSN Code Batch No Expiry Date Qty Service
S.No Particulars Discount

1300.00 260.00 1040.00

CONSULTATION-Rajan Chugh 999312
(OPHTHALMOLOGY, Room No:

B122) 1300.00 260.00 1040.00

TOTAL AMOUNT
260.00
Less Contractual discount

0.00 0.00
TOTAL TAX AMOUNT

1040.00
BILL AMOUNT
0.00
PAYOR SHARE
1040.00
PATIENT SHARE
260.00 0.00
TOTAL DISCR. DISCOUNT
1040.00
PAID BY PATIENT
1040.00
NET PATIENT PAYABLE
0.00
BILL ROUND OFF AMOUNT

Rupees In Words: Rupees One Thousand Forty only

Payor Details
LIMITED
Name POWER GRID CORPORATION OF INDIA

Address CHANDIGARH

-
TIN
NA
Pminden Kaur Cashier Manager
Prepared By

clinic, physiotherapy and psychology. Dr. Sunil Kumar (Renal

week in case of consultation only except psychaitry, pain
Note: One follow'yp consult free within amust be drawn in the name of Fortis Healthcare
Limited. The above payment is subject to realisation.
Its likely that, other
instruments
Surgeon).All Banking trainees (including DNB Trainees) nurses & other
healthcare
such as resident doctor, other doctors,
than the treating doctor/team. Medical assistants to access to medical care, right to respect
& dignity, Right to
PATIENT RIGHTS: Right
workers working in the hospital may participate in your
care processes. know
to information about the ailment, Right to
of health care providers, Right to consent, Right
privacy and confidentiality, Right to know the identity your PLEASE CONTACT 0172-4692266 TO AVAIL THIS
SERVICE.
HOME COLLECTION OF LAB SAMPLES IS AVAILABLE.
the expected cost of treatment.***** ******

Reciept Detail
**** *-*-*
Balance Amount Payment Mode
Receipt Date Amount
S.No Receipt N0.

1002/DP/2302/39619 03-Feb-2023 9:12 AMM 1040.0 0.00 card

( NABH

A UNIT OF FORTIS HEALTHCARE LIMITED

Regd. Office: Fortis Hospital, Sector 62, Phase - VIl, Mohali - 160062

CIN No. : L85110DL1996PLCO76704

Fortis SPECIALITY Hospital