c. DA Form 3647-1 (Inpatient Treatment Record Cover Sheet). The Inpatient
Treatment Record Cover Sheet is prepared as an original and three copies for each
patient admitted and for each case carded for record only. The DA Form 3647-1 is
imprinted on a four-part set with the admitting plate; the DA Form 3647 is prepared with a
typewriter. The information source for this form is the DA Form 2985 (Admission and
Coding Information). See figure 1-9.
Figure 1-9. DA Form 3647-1 (Inpatient Treatment Record Cover Sheet).
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