2-12.
OTHER FORMS FILED IN THE HEALTH RECORD
a. DA Form 3647 (Inpatient Treatment Record Cover Sheet (ITRCS)). This
form is completed for each hospital admission. See figure 2-9. DA Form 3647 is
designed as an original and three carbon copy, continuous set for use on a computer
printer. One copy is placed in the Health Record , along with a copy of the Narrative
Summary.
Figure 2-9. DA Form 3647 (Inpatient Treatment Record Cover Sheet)
MD0751
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