DA FORM 3647 Fillable – Army Pubs 3647 PDF

DAFORMFILLABLE.COM | DA FORM 3647 Fillable – Army Pubs 3647 PDF – In the realm of military health records, the DA FORM 3647, or the Inpatient Treatment Record Cover Sheet, plays a pivotal role. Established on May 1, 1979, this form is an essential document used within the United States Army Medical Department. This unclassified and publicly releasable document is designed to organize and cover critical aspects of inpatient medical treatment records.

DA FORM 3647 – Inpatient Treatment Record Cover Sheet

Form Number DA Form 3647
Form Title Inpatient Treatment Record Cover Sheet
Form Date 05/01/1979
Form Proponent TSG

Overview of DA FORM 3647

DA FORM 3647 is structured to serve as the front cover for inpatient treatment records, ensuring that all pertinent patient information is consolidated and easily accessible. As an active form prescribed by the Army Regulation (AR) 40-400, its consistent use is crucial for maintaining the integrity and continuity of medical documentation across military healthcare facilities.

Key Features of DA FORM 3647

The Inpatient Treatment Record Cover Sheet includes several essential features:

  • Uniformity: The form provides a standardized template for recording patient data, treatment plans, and medical history.
  • Accessibility: With a Dist Restriction Code of ‘A’, indicating it is approved for public release and distribution is unlimited, it ensures that those who need access to the form can obtain it without undue restriction.
  • Electronic Media: As noted by the footnote “42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA”, the form is primarily available in digital format, aligning with modern record-keeping practices.

Sections of DA FORM 3647

Patient Identification

At the top of DA FORM 3647, there is a section dedicated to patient identification. This includes:

  • Name
  • Rank
  • Social Security Number (SSN)
  • Date of Birth

This information ensures that each record is uniquely associated with the correct patient.

Medical Information

The form allows healthcare professionals to fill out comprehensive medical details about the inpatient’s condition and treatment. This section includes:

  • Admission and Discharge Dates
  • Diagnosis
  • Treatment Plan
  • Attending Physician’s Notes

These details are critical for a holistic understanding of the patient’s health journey.

Administrative Details

This part of the form includes:

  • Hospital or Medical Facility Name
  • Ward or Unit
  • Bed Number

These administrative details help in managing the logistical aspects of inpatient care.

Importance of DA FORM 3647 in Military Healthcare

DA FORM 3647 is more than just a form; it is a vital tool in the management of inpatient medical records. By providing a clear, organized way to compile and present patient information, it aids in:

  • Enhancing Patient Care: Ensuring that all medical professionals involved in a patient’s care have access to the same comprehensive data.
  • Facilitating Communication: Helping various departments within military medical facilities communicate more effectively.
  • Improving Record Accuracy: Reducing the likelihood of errors in patient records and improving the quality of care.


The DA FORM 3647 – Inpatient Treatment Record Cover Sheet is an indispensable part of the healthcare documentation process in the U.S. Army. By standardizing the way inpatient records are created and maintained, it plays a critical role in ensuring that military personnel receive the best possible medical care. Whether you are a medical professional, a healthcare administrator, or a service member, understanding how to use and interpret this form can significantly impact the effectiveness of military healthcare services.

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