Section II. COMPLETION OF THE INPATIENT TREATMENT RECORD COVER
a. Format. The format is the same for two variations of the Inpatient Treatment
Record Cover Sheet (ITRCS).
(1) DA Form 3647 (original and three carbon set) used for typed entries of
(2) DA Form 3647 (original and three carbon set) used for computer
b. Initial Information. The source of data for Items 1 through 30, (except Items
25, 26, and 33) is DA Form 2985 (Admission and Coding Information). DA Form 2985
is a dual purpose form serving as a patient admission information document and coding
transcript. It is used in Army medical treatment facilities (MTFs) not having automated
admission and disposition/clinical records processing. The initial information is
obtained by the admissions clerk. Nonautomated hospitals should complete applicable
fields of DA Form 2985 in an original and two legible copies at the time of admission.
The information is transferred from DA Form 2985 by typing the items onto DA Form
after the patient is dispositioned and the ITRCS is completed.
c. Attending Physician. The health care provider in charge of the case is
responsible for the diagnostic/operative information recorded in Item 34, this information
is verified by completion of the "Signature of Attending Medical Officer" block on the
ITRCS physician's worksheet.
d. Disposition Information. This information is completed by the Patient
Administration Division at the time of disposition of the patient. The ITRCS is completed
when the patient is discharged, returned to duty, transferred, dies, or is a CRO case.
This information is covered in detail in the next few paragraphs.
e. Recording of Dates. The dates are entered in sequence of day, month, and
year. Numerical symbols for months are not authorized.
f. CRO Cases. When preparing an ITRCS for CRO cases, Items 7, 14, 24, 27,
and 30 and name of admitting officer are not required.
g. Correction of ITRCSs. A corrected ITRCS must be completed and
forwarded as necessary to correct any item (except for MTF code and register number
which cannot be changed in the IPDS data base by the MTF). A corrected ITRCS must
include the register number, name of patient, FMP -SSN, date of disposition, and MTF
name as well as the information corrected. Both the erroneous entry and corrected