[DepartmentName]
Patient No
[PatID]
Gender / Age
[PatGenAge]
Name
[PatName]
Phone No
[PatPhone]
Address
[PatAddr1]
Date of Admission
[AdmDate]
[PatAddr2]
[CaptionDisDate]
[DisDate]
Mobile No
[Patmob]
Admitting Doctor
[Consultant]
[DisDetails]
[DisApproval]