Sample Laboratory Bill for Patient in Word Format
Laboratory Bill:
Lab Information Registration
Location:____________ Destination
Location:___________ Registration
Date:__________
Patient Bill:
S.No. | Test Name | Reporting Date | Time | Rate |
| 1. | BLOOD C/E (complete, CBC)Hb,WBC Count (TLC), DLC, Total RBC, Platelet count, MCV, MCH, MCHC, Type | Date: xx-xx-xx | xx.xx | xxx/-
|
| 2. | ESR | Date: yy-yy-yy | yy.yy | yyy/- |
| 3. | Vitamin | Date: nn-nn-nn | nn.nn | nnnn/- |
Total Bill:
Total: xxxx.00
Less/ Discount yyy.00
Paid: xxxx.00
To be paid: xxxx.00
Registered By: _____________
Collection Center:
Center Name: ___________
Phone no.____________
Fax no._____________
Contact Person: _____________
Address:__________________
