DA Form 3647. Inpatient Treatment Record Cover Sheet

Form DA 3647 is a cover sheet used to organize and summarize the contents of an inpatient treatment record within a military medical facility. This form helps identify and provide an overview of the medical documentation related to a specific inpatient treatment episode.

The form consists of sections where the patient's personal information, medical facility details, and treatment episode information can be recorded. It may include sections for documenting the patient's admission and discharge dates, primary diagnosis, attending physician, and any significant medical events or procedures during the treatment period.

Important fields in this form include the patient's personal information, treatment episode details such as admission and discharge dates, primary diagnosis, attending physician, and any significant medical events or procedures. It is crucial to accurately record the information to ensure proper organization and retrieval of the inpatient treatment record.

Application Example: Military medical facilities can use this form as a cover sheet for organizing and summarizing the contents of an inpatient treatment record. The form should be completed with accurate and complete information about the patient, treatment episode, and any relevant medical events or procedures. This form helps facilitate efficient management and retrieval of inpatient medical records within the military healthcare system.

Related Forms: Form DA 3647-1 is a variant of the Inpatient Treatment Record Cover Sheet specifically designed for plate imprinting purposes. Depending on the specific context or purpose, other forms related to medical documentation, patient records, or healthcare administration may exist within the military medical system.