[RptHeader]

[DepartmentName]

Patient No	[PatID]	Gender / Age	[PatGenAge]
Name	[PatName]	Mobile No	[Patmob]
Address	[PatAddr1]	Date of Admission	[AdmDate]
	[PatAddr2]	[CaptionDisDate]	[DisDate]
NS/Bed No	[WardBed]

[OPDNumber]