Concession Request Form

Date
OPD Year
OPD No
IPD No

Patient Name
Sex
Department
Address


Select Concession Request
  

Select Department


Select Main Test
Add Main Test


Select Sub Test
Add SubTest

Test Amount                      
Concession Amt                      

Final Paid Amount

Concession For                      
                     
College Name                      

Concession Recommended By                      

-

SrNo Patient Name Department Main Test Sub Test Test Amt Concession Amt Delete
SrNo Patient Name Department Main Test Sub Test Test Amt Concession Amt


Godavari Foundation's
Dr. Ulhas Patil Medical College And Hospital
RECEIPT
Receipt No. Date :
Patient Name :
OPD No. : IPD No. :
Department :
PARTICULARS AMOUNT
Pay Mode :
Cheque No/Online Deatails :
Bank Name :
Concession Approved By :
Hospital Copy
Godavari Foundation's
Dr. Ulhas Patil Medical College And Hospital
RECEIPT
Receipt No. Date :
Patient Name :
OPD No. : IPD No. :
Department :
PARTICULARS AMOUNT
Pay Mode :
Cheque No/Online Deatails :
Bank Name :
Concession Approved By :
Patient Copy

.Copyright © Website 2019.

Designed, Developed and Maintained by: Godavari Foundation's Software Development Cell,Jalgaon, Maharashtra, India.