Payment
Payment Details
MRN/Debtor Code
Payer Name
Payment Type
Payment Mode

Card Details
Card Type
C/Card No
Authorization No
Expiration Date

Cheque Details
Cheque No
Cheque Date
Bank Name


Payment
Payment Amount Amount Received Amount Change:
For Bank Deposit Paid :
Remarks
Outstanding Bills
  Bill No Bill Date MRN Visit/Adm No Patient Name Bill Amount O/S Amount Not Covered Amount Pay Amount Bill Type
                   
*                    
Payment Total: 0.00 0.00 0.00 0.00
 
Existing Receipt No
Receipt No
Receipt No: