Solution : https://service.sap.com/sap/support/notes/528220 (SAP Service marketplace login required)
Key words : 
software distribution center-> installations & upgrades   -> industry-specific components      -> public sector         -> patient management            -> sap patient management 4, change history date       theme       short description------------------------------------------------------------------------mar/03/06  var, avoidingupdate terminations                          usingtransaction se11 -> display database table, sapcar '-xvf /qopt/<volid>/data/kish77g, sapcar -xvf /<cd_dir>/data/kish77g, software distribution center, 63b    -> supplementary upgrade              -> delta upgradeyou, transport directory medium--------------------------------------------------------- required releases---------------------------------------------------------, 'select single request' field, latest spam/saint updatemake
Related Notes : 
       
| 212075 | Release strategy for IS-H | 
| 212072 | IS-H collection note: Overview of notes for Release 4.6 |