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Patient Information
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Patient Name
REG NO
Age
NIC
Contact No
Insurance Provider
Policy No
Doctor
Room Number
Date
Channeling Charges
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Date
Doctor Name
Specialization
Type
Amount (LKR)
Action
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Medicine Charges
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Date
Medicine Name
Dosage
Quantity
Unit Price (LKR)
Amount (LKR)
Action
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Treatment Charges
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Date
Treatment Name
Type
Duration
Amount (LKR)
Action
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Room Charges
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Date Range
Room Type
Days
Rate per Day (LKR)
Amount (LKR)
Action
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Diagnostic Charges
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Date
Test Name
Laboratory
Amount (LKR)
Action
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Summary Charges
Doctor Visit Charges (LKR)
Service Charge (%)
Insurance Coverage (%)
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