Hospital Management Software
| Bed Head Ticket: |
| Hospital | District | ||||||
| Regn. No. | IPD No. | Referred by Doctor | |||||
| Password | Room | Bed No. | |||||
| Name | (First) | (M) | (Last) | ||||
| Occupation | Income | ||||||
| Age | Gender | ||||||
| Address 1 | BPL | YES NO | |||||
| Address 2 | Place | ||||||
| Diagnosis: | Provisional on Admission | ||||||
| Final | |||||||
| Date of admission | (DD-MM-Year) | Result | |||||
| Date of Surgery | (DD-MM-Year) | Date of Discharge | (DD-MM-Year) | ||||
| Entitled for Free Treatment | YES NO | ||||||
| Rural Urban | Dieted Non-Dieted | ||||||