Solution : https://service.sap.com/sap/support/notes/528210 (SAP Service marketplace login required)
Key words : 
software disribution center-> installations & upgrades   -> industry-specific components      -> public sector         -> patient management            -> sap patient management 4, change history date    theme                  short description------------------------------------------------------------------------ 1, sapcar ' -xvf /qopt/<volid>/data/kish75g, sap system data/component version, sapcar -xvf /<cd_dir>/data/kish75g, specific/issl/ish/space463b, 63b               -> supplementary upgrade               -> installation pi, software distribution center, 'select single request' field, newest spam/saint updatemake
Related Notes : 
       
| 212075 | Release strategy for IS-H | 
| 212072 | IS-H collection note: Overview of notes for Release 4.6 |