GIMSR Hospital Receipts
Hospital Receipt Code
Special characters are not allowed!
Remitted By
* Remitted By is mandatory
Remarks
* Remarks are mandatory
Institute
Campus
Hospital Head Code
0.Hospital Receipts
1.Sample Collection at Dental College
2.Sample Collection at Central Lab
3.Casuality
4.OT Charges
5.Physiotherapy
6.X-RAY
7.ECG
Total fee
DD
Cash
Reference Number
Bank Name
Amount in Rs.
Instrument Date
Select Bank
UBI
Indian bank
