DA FORM 3647-1 Fillable – Army Pubs 3647-1 PDF

DAFORMFILLABLE.COM | DA FORM 3647-1 Fillable – Army Pubs 3647-1 PDF – DA FORM 3647-1, commonly referred to as the Inpatient Treatment Record Cover Sheet (For Plate Imprinting), is an essential document used by healthcare providers within the military. This form plays a pivotal role in maintaining accurate and comprehensive medical records for inpatients. Its structured format ensures that critical patient information is recorded systematically, facilitating efficient treatment and continuity of care.

DA FORM 3647-1 – Inpatient Treatment Record Cover Sheet (For Plate Imprinting)

Form Number DA Form 3647-1
Form Title Inpatient Treatment Record Cover Sheet (For Plate Imprinting)
Form Date 05/01/1979
Form Proponent TSG

What is DA FORM 3647-1?

DA FORM 3647-1 is a standardized document used by the United States Army to keep track of inpatient medical treatments. It serves as a cover sheet for the inpatient treatment record, specifically designed for plate imprinting. Established on May 1, 1979, this form has been actively used to improve the organization and accessibility of patient information.

Key Features of DA FORM 3647-1

  • Publication Date: The form was officially published on May 1, 1979.
  • Title: It is officially titled as the “Inpatient Treatment Record Cover Sheet (For Plate Imprinting).”
  • Status: The form is currently active and widely used within medical facilities in the military.
  • Proponent: The Surgeon General (TSG) is the proponent of this form.
  • Security Classification: It is classified as UNCLASSIFIED, meaning it is approved for public release and its distribution is unlimited.

Importance of DA FORM 3647-1 in Military Healthcare

The DA FORM 3647-1 is critical in the healthcare management of military personnel. By providing a structured way to record detailed inpatient treatments, it contributes significantly to patient care.

Benefits of Using DA FORM 3647-1

  • Enhanced Record Keeping: Ensures that all pertinent patient information is neatly organized and easily accessible.
  • Continuity of Care: Facilitates communication among healthcare providers, leading to consistent treatment across various medical facilities.
  • Efficiency: The design of the form allows for quick updating and plate imprinting, speeding up administrative processes.

How to Use DA FORM 3647-1

Understanding how to fill out and use DA FORM 3647-1 correctly is crucial for medical personnel. Here are the steps involved:

Filling Out the Form

  1. Patient Identification: Enter all relevant patient information, including name, rank, and service number.
  2. Medical Facility Information: Document the name and location of the medical facility providing treatment.
  3. Treatment Details: Record the specific treatments administered to the patient, along with dates and times.
  4. Physician’s Notes: Include any observations or special instructions from the attending physician.

Guidelines for Medical Personnel

  • Ensure all information is accurate and up-to-date.
  • Use the form consistently for all inpatients to maintain standardized records.
  • Retain the form as part of the patient’s permanent medical record.


DA FORM 3647-1 – Inpatient Treatment Record Cover Sheet (For Plate Imprinting) is a vital tool in the management of inpatient medical records within the military. Its structured format and clear guidelines ensure that patient information is systematically recorded and preserved, aiding in effective treatment and care continuity. By using this form, healthcare providers can enhance their administrative efficiency and focus more on delivering quality care to their patients.

DA FORM 3647-1 Fillable – Army Pubs 3647-1 PDF DOWNLOAD

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