Sample Laboratory Bill for Patient in Word Format

Sample Laboratory Bill for Patient in Word Format

 

Laboratory Bill:

Lab Information Registration

Location:____________ Destination

Location:___________ Registration

Date:__________

 

Patient Bill:

S.No.

Test NameReporting DateTime

Rate

1.BLOOD C/E (complete, CBC)Hb,WBC Count (TLC), DLC, Total RBC, Platelet count,  MCV, MCH, MCHC, TypeDate: xx-xx-xxxx.xx 

xxx/-

 

2.ESRDate: yy-yy-yyyy.yyyyy/-
3.VitaminDate: nn-nn-nnnn.nnnnnn/-

 

 

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:__________________