| Sr. | Description of Medical Services / Treatment | Amount (PKR) |
|---|---|---|
| 1 | ||
| 2 | ||
| 3 | ||
| 4 | ||
| 5 | ||
| 6 | ||
| 7 | ||
| 8 | ||
| 9 | ||
| 10 | ||
| 11 | ||
| 12 | ||
| 13 | ||
| 14 |
Sub Total:
___________
Discount:
___________
Total Paid:
___________
Patient / Receiver Signature
Authorized Signature & Medical Stamp