Get Da 3647 1979-2026

The DA 3647 is an essential tool for documenting inpatient treatment records. Understanding how to accurately fill out this form online is crucial to ensure proper medical documentation and compliance with regulations.

Follow the steps to accurately complete the DA 3647 online.

1. Click ‘Get Form’ button to obtain the DA 3647 and open it in the editor.
2. Input the register number in the designated field. This unique identifier is necessary for tracking patient records.
3. Enter the patient's name (last, first, MI) in the appropriate section.
4. Fill in the age and sex of the patient, ensuring accurate representation.
5. Provide the patient’s race and religion in their respective fields.
6. Complete the Social Security Number (SSN) field for identification purposes.
7. Indicate the length of service for military personnel and their grade.
8. Record the organization and branch/corps associated with the patient.
9. Fill in any prior admission details and the date of this admission.
10. Input the source of admission and authority for admission.
11. Document the name and relationship of the emergency addressee, along with their address, including ZIP code.
12. Provide medical treatment facility details and selected administrative data.
13. Record relevant dates for initial admission and any major procedures or diagnoses.
14. Fill out sections on military status, type case, and clinic service for comprehensive data.
15. Complete the signature sections for the admitting officer and the attending medical officer.
16. After ensuring all fields are accurately filled, users can save changes, download, print, or share the completed form.

Complete your DA 3647 form online now for timely and accurate medical record documentation.