Download the form
DA Form 3647-1 is a Department of the Army form in the DA series. Title of record: INPATIENT TREATMENT RECORD COVER SHEET (FOR PLATE IMPRINTING). Function: inpatient treatment record cover sheet (for plate imprinting). The edition presently published bears the date 05/01/1979, with a status of ACTIVE. Physical extent is 2 page(s) and about 161 fillable fields.
The office of primary responsibility is TSG. Use is prescribed by AR 40-400, which defines when the form is raised and where it goes afterward. The form is normally completed by the subject of the entries or by administrative personnel maintaining the record, then reviewed and signed as the governing authority directs.
Available formats: PDF, XFDL. Each is a rendering of the same official layout; the content is identical across them and only the means of completion differs. The pdf is the reference copy. Fillable pdf carries interactive form fields; a printable pdf is the same page image without them, intended for pen entry after printing.
The pdf displays in current browsers and in any reader application. For fillable use a full reader is preferable to a browser viewer, since viewers vary in whether entered data is retained. An xfdl file is available too. The format is IBM Lotus Forms, in use across Army form systems, and it opens only in the Lotus Forms Viewer.
All formats are free to download and no registration is involved. The files are the published documents, distributed unmodified.
What the form asks for
- AdmitOff
- CAUSE
- CONT_B
- Cont_A
- ContentArea1
- ContentArea2
- Continue
- DIAGNOSES
- Data
- DataItems
- Date
- Days_A
- Days_AA
- Days_AB
- Days_AC
- Days_AD
- Days_AE
- Days_AF
- Days_B
- Days_C
- Days_D
- Days_E
- Days_F
- Page1
The blocks are worked through in the order they appear on the sheet. At the head sit the identifying entries: name, identification number, unit, date. Because the filed record is indexed on these, they precede everything substantive.
Typed entry is made straight into the interactive fields. The tab key moves through them in the order set at build time, generally matching the reading order of the page. Boxes and buttons respond to a click; in an exclusive group, one selection cancels the others. Single-line fields do not wrap, and anything longer than the field width prints cut off although it may still display in full on screen. Extended text goes to remarks or a continuation sheet rather than into a narrow box.
The signature block is completed last and by hand or by an accepted electronic means. An unsigned form is a draft. Where a second signature is called for — reviewing official, approving authority, witness — each is applied in the order the blocks appear and dated as of application, not as of preparation. Blank mandatory fields are the most frequent defect; a nil entry is marked as such rather than left empty. Other recurring faults: transposed digits in identification numbers, dates in the wrong order of day and month, and stale copies retaining prior data because a working file was reused instead of a fresh blank form.
A Privacy Act statement appears on the form where personal information is collected. It sets out the authority for collection, the purpose, the routine uses, and whether disclosure is mandatory or voluntary. The statement is read before entry, not after. Completed copies carry personal data and are handled and stored under the safeguards applicable to that data.
Once completed, the form goes where the governing authority directs: to the designated office, along the unit administrative channel, or into the personal file. The preparer retains a copy. The length of retention and the manner of filing are set by the records schedule for the series, not by local arrangement.
Associated documents are located through the series and number scheme. Forms in the DA series with the same proponent or the same prescribing directive tend to be used as a set, and any form named on the face of another normally accompanies it. Continuations, cover sheets, and transmittals fall into this category and are gathered before the package is sent.
Editions are replaced when the proponent revises the content. The edition date printed on the form is the means of telling one version from another, and the date on a downloaded copy is checked against the edition in force before use. Records already executed on a prior edition are not reworked on that account.
The files here are reproductions of published Department of the Army documents, provided for download. This site is not part of the Department of the Army and issues no forms of its own. Nothing on this page is legal advice, and no representation is made as to acceptance of a document by any office. Where an entry, a requirement, or a question of eligibility is in doubt, the proponent or the servicing administrative office answers it.
Questions and answers
- What is DA Form 3647-1?
- INPATIENT TREATMENT RECORD COVER SHEET (FOR PLATE IMPRINTING)
- Which edition is current?
- 05/01/1979
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, XFDL, PDF