Da Form 3647 For use of this form see ar 40 400 the proponent agency is otsg dept ben date of intial admission units of whole blood component transfused 30 admitting officer signature of pad or medical records officer previous da form 3647 may 79 edition of 1 aug 76 is obsolete usappc v1 10
Form DA 3647 is a cover sheet used to organize and summarize the contents of an inpatient treatment record within a military medical facility This form helps identify and provide an overview of the medical documentation related to a specific inpatient treatment episode The form consists of sections where the patient s personal information medical facility details and For use of this form see AR 40 400 the proponent agency is the Office of The Surgeon General PATIENT DATA ITEMS 1 30 Excluding Items 25 26 LINE LEGEND 1 REGISTER NO NAME GRADE DA FORM 3647 1 1 MAY 1979 EDITION OF 1 AUG 1976 IS OBSOLETE USAPA V1 00 Created Date
Da Form 3647
Da Form 3647
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Dads Form 3647 ≡ Fill Out Printable PDF Forms Online
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For use of this form see ar 40 400 the proponent agency is otsg dept ben date of intial admission units of whole blood component transfused 30 admitting officer signature of pad or medical records officer previous da form 3647 may 79 edition of 1 aug 76 is obsolete usappc v1 10
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Form DA 3647 is a cover sheet used to organize and summarize the contents of an inpatient treatment record within a military medical facility This form helps identify and provide an overview of the medical documentation related to a specific inpatient treatment episode The form consists of sections where the patient s personal information medical facility details and
Fillable Online U.S. Army Form DA-3647. INPATIENT TREATMENT RECORD COVER SHEET Fax Email Print - pdfFiller
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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 For use of this form see AR 40 400 the proponent agency is OTSG ADMITTING OFFICER 36 Total Days All Facilites 35 Total Days This Facility ABSENT SICK DAYS ADMISSION REMARKS DA FORM 3647 MAY 1979 EDITION OF 1 AUG 76 IS OBSOLETE APD LC v1 11ES INPATIENT TREATMENT RECORD COVER SHEET DATE OF INTIAL ADMISSION UNITS OF WHOLE BLOOD
Access and download a free fillable DA Form 3647 1 Inpatient Treatment Record Cover Sheet For Plate Imprinting in Word and PDF format Easily fill the form online and save it as a ready to print PDF document Get the blank template now 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
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Dads Form 3647 ≡ Fill Out Printable PDF Forms Online
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Da Form 7222 1 Fillable ≡ Fill Out Printable PDF Forms Online
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For use of this form see AR 40 400 the proponent agency is the Office of The Surgeon General LINE LEGEND 1 35 TOTAL DAYS THIS FACILITY 36 TOTAL DAYS ALL FACILITIES DA FORM 3647 1 1 MAY 1979 EDITION OF 1 AUG 1976 IS OBSOLETE APD LC v1 01ES SEX AGE RACE RELIGION LENGTH OF SVC ETS PRE VIOUS ADMISSION FMP SSN An MTF Cover Sheet DA Form 3647 or DA Form 3647 1 summarizing the treatment provided is filed in the patient s permanent MD0920 1 2 outpatient medical record Health Record HREC or Outpatient Treatment Record OTR The MTF is maintained by the facility for a specified time usually 1 year for a
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Figure 1-8. DA Form 3153 (MSA Patient Ledger Card). - Patient Accountability Branch
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Da Form 7566 ≡ Fill Out Printable PDF Forms Online
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Da Form 7566 ≡ Fill Out Printable PDF Forms Online
Figure 1-8. DA Form 3153 (MSA Patient Ledger Card). - Patient Accountability Branch
Da Form 3715 ≡ Fill Out Printable PDF Forms Online
MEDICAL RECORDS AND SICK CALL PROCEDURES
Dads Form 3647 ≡ Fill Out Printable PDF Forms Online
DA Forms 3238 - 3697 | Forms - Docs - 2023
DA Forms 3238 - 3697 | Forms - Docs - 2023
Dads Form 3647 ≡ Fill Out Printable PDF Forms Online
AR 25--400-2- 26 February 1993
Figure 2-8. DA Form 5571 (Master Problem List) (concluded). - Outpatient Medical Records Branch
Da Form 3647 - 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