INPATIENT TREATMENT RECORD COVER SHEET
Section I. GENERAL
a. Purpose. AR 40-66, defines the purposes and use of DA Form 3647,
Inpatient Treatment Record Cover Sheet (ITRCS) as a medical and administrative
summary of each case. An Inpatient Treatment Record (ITR) consists of the ITRCS
and other forms prepared and used during a current, uninterrupted period of treatment
for a patient who is hospitalized. The ITRCS is an essential document for the Health
Record (HREC) and Outpatient Treatment Record (OTR). It also serves as a source
document for statistical information of major military and medical interest, and as a legal
document in third party liability cases.
b. Use of Inpatient Treatment Record Cover Sheet. All hospitals (fixed and
nonfixed) and convalescent centers are required to use the ITRCS. In overseas
commands, the ITRCS may also be used, at the discretion of the theater or command
surgeon, by clearing stations designated and staffed as nonfixed hospitals.
c. For Whom Prepared. The ITRCS is prepared for:
(1) All bed patients (military or civilian) admitted to a fixed or field hospital, or
(2) Liveborn infants.
(3) Carded for Record Only (CRO) cases. CRO is a classification used for:
(a) Cases when the patient is d ead on arrival at the medical treatment
(b) Disability separations/retirement (medical board) cases processed on
an outpatient basis.
(c) Selected medicolegal cases such as rape or assault. Such cases
require a record for the MTF.
(1) The MTF commander has the overall responsibility for the preparation,
safeguarding, and forwarding of inpatient records.