Hospital Bill Template
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1
2HOSPITAL BILL
(Hospital Letter Head)
Bill No:
Bill Date:
Name of Patient________________________________________________________________, Age/Sex______,
Address_____________________________________________________________________________________,
Date / Time of Admission____________________________, Date / Time of Discharge_____________,
Name of Treating Doctor____________________________________, Department________________,
Accommodation Type______________________________________, Room No___________________,
Diagnosis:___________________________________________________________________________,
Code Billing Heads
Rate
Quantity Amount in Rs.
1
Room Rent
2
Nursing Charges
3
RMO Charges
4
IV Fluids Administration Charges
5
Blood Transfusion Administration Charges
6
Injection Charges
7
Similar expenses as Above
Total Room Rent Services
1
ICU Rent
2
ICU Nursing Expenses
3
ICU RMO charges
4
IV Fluids Administration Charges
5
Blood Transfusion Administration Charges
6
Injection Charges
7
Similar expenses as Above
Total ICU Services
1
Surgeon Charges
2
Anesthetist Charges
3
Medical Practitioner Charges
4
Consultants Charges
5
Specialist Charges
Total Professional Fee
1
Anesthesia
2
Blood
3
Oxygen
4
Operation Theater Charges
5
Surgical Appliances
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Parent category: Medical