Ref. No.: FRR/Vinayak/1027/2020-21

Dated: 15.07.2020

PROFORMA INVOICE / FUND REQUISITION REPORT:

(A Vinayak Burn Centre Noida Initiative)

Stage 1:

Funds - Hospital Stay(ICU and Ward) 2,25,000.00

Funds - RMO, Nursing, Consultants & Specialists 1,82,000.00

Funds - Dressing & Procedures 2,50,000.00

Funds - Rehabillitation (Physiotheraphy) 15,000.00

Funds - Medicines + Consummables + Transfusions 2,92,000.00

Funds - Pathology & Diagnostics 18,500.00

Total (in numbers) 9,82,500.00

Date of Admission: 06/04/2020.

Summary Analysis: The patient - Baby Gunjan was brought in to our hospital by her father - Mr. Satyaveer on 6th April 2020.The

child has sustained Thermal Burn Injury due to accidentally coming in contact with hot oil while she was at home. The child was

playing at home and contacted with hot oil when her mother was warming oil for making food ,she fall into hot oil so that she

burnt . As a result of the incident, the child has sustained mostly 2nd & 3rd Degree Deep 45% TBSA Thermal Burn Injury. The

Burns are on Chest, abdomen, hands & leg area. The nature of injury is life threatening and requires considerable degree of

specialist intervention and close monitoring. The patient is a child of 8 years, she has been under constant treatment and has

undergone a skin grafting procedures that has failed due to the nature of the injury. She has been advised to be under

observation and to undergo a final skin grafting surgrey to treat the wound. Post the procdeure, she will undergo Physiotherapy

sessions and Pressure Garments would also be advised to achieve the best possible results against a possible pulmonary collapse

and for a contracture and scar free recovery.

Fund Requirement - During Hospital Stay

Patient Name: Baby Gunjan.

Sex: Female Age: 8 years.

Father Name: Mr. Satyaveer.

Address: Vill. Havetpur Radha Krishna Mandir, Greater Noida (U.P.)

Diagnosis: Approx 45% Thermal Burn.

Visuals: At Admission Current Pictures:

Please find below the detailed Medical Expenses for treatment till 15th July'20.

Total (in words): Nine Lakh Eighty Two Thousand Five Hunderd Only

Stage 2:

Funds - Hospital Stay(ICU and Ward) 40,500.00

Funds - RMO, Nursing, Consultants & Specialists 32,000.00

Funds - Dressing & Procedures 72,300.00

Funds - Medicines + Consummables + Transfusions 61,200.00

Funds - Pathology & Diagnostics 6,000.00

Total (in numbers) 2,12,000.00

Funds - Follow Up Visits & Dressings 4,000.00

Total (in numbers) 4,000.00

Fund Requirement - TOTAL

Stage 1 9,82,500.00

Stage 2 2,12,000.00

Stage 3 4,000.00

Fund Received 5,50,000.00

Total (in numbers) 6,48,500.00

Kindly release the funds at the earliest for us to go ahead and execute the treatment for Baby Gunjan .

For Vinayak Burn Centre

(A Division of Vinayak Hospital)

5th Floor, Vinayak Hospital, Sector 27, Atta Market,

NH - 1, Noida - 201301 (UP)

AO/AD

Total (in words): Two Lakh Twelve Thousand Only

Total (in words): Four Thousand Only

Total (in words): Six Lakh Forty Eight Thousand Five Hundred Only

Fund Requirement - Follow Up

Please find below the detailed fund requirement for Follow Up period of 1.0 Month Post Discharge.

Please find below the detailed fund requirement for Stage 2 Treatment till 04th August'20.