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Bed Prices(In Rials):
Daye Care Room
Bed in Emergency Department
Neo Nate Bed
Chemo Therapy Bed
Doctors fees will be entirely in the hands of the responsible doctor in charge of patient.
I undertake the responsibility for the payment of the Hospital Expanses and
doctors fee in respect of my admission and in-patient stay and treatment in Pars Hospital.
I …………… , the patients …………… am fully informed of the expenses involved in the treatment of my patient. I undertake the responsibility for the payment of all the bills and doctors fees to the Account Depatment of the hospital.
Should I fail to do so, Hospital is entitled to take legal action to claim the fees.
Accompanying Person Signature and Finger Print:…………..
Patients signature and Finger Print…………
I am handing over all my valuable belongings & / or cash to my accompanying oerson or The Hospital Cash Department.
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