123 Main Street, Cityville, State, 123456
Contact: +1 (555) 123-4567 | Website: www.A1hospital.com
| S.No. | Item Code | Item Desc | Qty | Gross Amount ($) | Discount ($) | Patient Share ($) | Tax Amount ($) | Net Bill ($) |
|---|---|---|---|---|---|---|---|---|
| 1 | MED209 | Orthopedic Consultation | 1 | 200.00 | 20.00 | 36.00 | 9.00 | 189.00 |
| 2 | MED210 | Knee X-Ray | 2 | 300.00 | 30.00 | 54.00 | 13.50 | 283.50 |
| Total | 500.00 | 50.00 | 90.00 | 22.50 | 472.50 |
Disclaimer: This is a system-generated invoice copy and does not require any seal or signature. In case of any changes in the billed services or amount, the final invoice can be verified using our app. Any excess amount paid in cash or card will be kept in the patient account. For further assistance, contact our support team.