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  • 4-Summary of Mediclaim Expenses - 1

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    DT world
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    summery

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    4-Summary of Mediclaim Expenses -1

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    12 vues4 pages

    4-Summary of Mediclaim Expenses - 1

    Transféré par

    DT world
    summery

    Droits d'auteur :

    © All Rights Reserved
    Téléchargez comme XLS, PDF, TXT ou lisez en ligne sur Scribd
    Signaler comme contenu inapproprié
    sur 4

    EXPENSE SUMMARY

    SUMMARY OF MEDICAL EXPENSES INCURRED

    EC NO:- 20185308 Name:- Mr.Ketan Doshi

    Bill/Receipt
    Sr. No Date Name of Hospital/Medical Store/Doctor Amount
    No
    1 11/22/2011 R1208999 Umkal Hospital 5200.00

    2 11/20/2011 R1208924 Umkal Hospital 650.00

    3 11/22/2011 C12008658 Nirmal Pharmacy 636.00


    4 11/22/2011 C12008649 Nirmal Pharmacy 62.00

    5 11/20/2011 C12008585 Nirmal Pharmacy 494.00

    7042.00
    Rs. . Rupees Seven Thousand Forty Two Only

    Date:
    Place:

    Signature
    EXPENSE SUMMARY

    SUMMARY OF MEDICAL EXPENSES INCURRED

    FIR 1896724 Name:- Mr.Prashant Vaishnav

    PHS ID: 10831320


    Bill/Receipt
    Sr. No Date Name of Hospital/Medical Store/Doctor Amount
    No
    1 6/27/2011 6066 Swapn Healthcare Hospital Pvt Ltd. 9720.00

    2 7/5/2011 49821 Jay Girnari Medical 436.00

    3 7/22/2011 5985 Jay Girnari Medical 701.00

    4 7/12/2011 27614 Shree Siddhi Vinayk Hospital 70.00

    5 7/7/2011 2100 Shree Siddhi Vinayk Hospital 150.00

    6 7/7/2011 3822 -3823 New Sidhi Vinayak Medicines 331.00

    7 7/7/2011 3822-3823 New Sidhi Vinayak Medicines 404.00

    11,812
    Rs. . Rupees Seven Thousand Forty Two Only
    EXPENSE SUMMARY

    SUMMARY OF MEDICAL EXPENSES INCURRED

    E.C.NO 20185581 Name:- Mr.Harsh Mehta

    PHS ID:
    Bill/Receipt
    Sr. No Date Name of Hospital/Medical Store/Doctor Amount
    No
    1 11/25/2011 Medicine Bill 200.00

    2 11/13/2011 76 Tender Touch 9600.00

    3 11/11/2011 535 Shree Siddhivinayk Medical & General Stores 48.00

    4 11/17/2011 587 Shree Siddhivinayk Medical & General Stores 451.00

    5 11/14/2011 6557 Shree Siddhivinayk Medical & General Stores 274.00

    6 11/14/2011 6558 Shree Siddhivinayk Medical & General Stores 102.00

    7 11/12/2011 6537 Shree Siddhivinayk Medical & General Stores 814.00

    8 11/12/2011 6538 Shree Siddhivinayk Medical & General Stores 210.00

    9 11/13/2011 6549 Shree Siddhivinayk Medical & General Stores 274.00

    10 11/13/2011 6550 Shree Siddhivinayk Medical & General Stores 419.00


    11 11/11/2011 6531 Shree Siddhivinayk Medical & General Stores 183.00

    12 11/11/2011 6530 Shree Siddhivinayk Medical & General Stores 828.00

    13 11/16/2011 6574 Shree Siddhivinayk Medical & General Stores 449.00

    14 11/17/2011 6579 Shree Siddhivinayk Medical & General Stores 481.00

    15 11/10/2011 6523 Shree Siddhivinayk Medical & General Stores 44.00


    16 11/10/2001 6525 Shree Siddhivinayk Medical & General Stores 119.00

    17 11/10/2011 6529 Shree Siddhivinayk Medical & General Stores 78.00

    18 11/10/2011 6522 Shree Siddhivinayk Medical & General Stores 483.00

    19 11/12/2011 14077 VIP Diagnostics 200.00

    20 11/15/2011 278 Raksha Digital X-Ray 300.00


    21 11/17/2011 2466 Tender Touch 1500.00

    22 11/15/2011 6529 Shree Siddhivinayk Medical & General Stores 16.00

    23 11/15/2011 6568 Shree Siddhivinayk Medical & General Stores 548.00

    24 11/19/2011 10934 Umiya Medical Store 311.00


    25 11/18/2011 17159 Pragati Medicines 87.00

    26 11/10/2011 6521 Shree Siddhivinayk Medical & General Stores 266.00

    27 11/10/2011 6520 Shree Siddhivinayk Medical & General Stores 418.00

    28 11/9/2011 271 Raksha Digital X-Ray 300.00

    29 11/9/2011 DialIndai Pvt Ltd 15.00

    30 11/7/2011 Rajmal Mehta DialIndai Pvt Ltd 121.00

    31 11/5/2011 Rajmal Mehta DialIndai Pvt Ltd 107.00

    32 11/5/2011 244 Supratech Micropath 310.00

    19,556
    Rs. . Rupees Seven Thousand Forty Two Only
    EXPENSE SUMMARY

    SUMMARY OF MEDICAL EXPENSES INCURRED

    E.C.NO 10001024 Name:- Kaushik Patel

    PHS ID:
    Bill/Receipt
    Sr. No Date Name of Hospital/Medical Store/Doctor Amount
    No
    1 2/16/2012 639 Accurate Pathology Lab 170.00

    2 3/6/2012 640 Accurate Pathology Lab 170.00

    3 2/28/2012 64041 K.R.Medical Pharmacy 4567.00

    4 2/28/2012 64083 K.R.Medical Pharmacy 374.00

    5 2/28/2012 8171 Hemato-Oncology Clinic Pvt.Ltd 2200.00

    6 2/22/2012 63064 K.R.Medical Pharmacy 126.00

    7 2/22/2012 2054 Vedanta Diagnostics 200.00

    8 2/22/2012 8039 Hemato-Oncology Clinic Pvt.Ltd 350.00

    9 2/7/2012 60209 K.R.Medical Pharmacy 268.00

    10 2/7/2012 60178 K.R.Medical Pharmacy 4500.00

    11 2/7/2012 7684 Hemato-Oncology Clinic Pvt.Ltd 800.00

    12 2/7/2012 7682 Hemato-Oncology Clinic Pvt.Ltd 2200.00

    13 2/6/2012 3927 Vidhi Imaging Center 800.00

    14 2/6/2012 2/6/2012 Shilp Pathology 2080.00

    15 2/7/2012 312 Jatan Medical & Children Hospital 3020.00

    21,825
    Rs. . Rupees Seven Thousand Forty Two Only

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