![da-form-3647](https://cdn.cocodoc.com/cocodoc-form/png/da-form-3647-x-01.png)
form 3647
Inpatient treatment record cover sheet for use of this form, see ar 40400; the proponent agency is otsg 1. register number 4. sex 11. fmp 15. flying status 21. source of admission/authority for admission 24. name/relationship of emergency...
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