IP No : [IpNo]
[RptHeader]
DEPARTMENT OF ENT-HEAD & NECK SURGERY
Hospital No [PatID] Gender / Age [PatGenAge]
Name [PatName] Mobile No [Patmob]
Address [PatAddr1] Date of Admission [AdmDate]
[PatAddr2] [CaptionDisDate] [DisDate]
Ward/Bed No [WardBed] Consultant [Consultant]
Surgery Date [SurgDate]
[DisDetails]
[DisApproval]
Place : Kollam

Date : [RDate]
For Emergency Please Contact : [2721520/2729393 (24 hrs) 2721630 (9 am to 4 pm)]