Get Na Form 13042 - Request For Information Needed To Locate Medical ...

Filling out the NA Form 13042 is an important step in requesting medical records for military service members and their dependents. This guide provides clear instructions on how to complete the form online, ensuring that you provide all necessary information to facilitate your request.

Follow the steps to successfully complete the NA Form 13042 online.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Complete Section I – About the Patient. Enter the patient's name, date of birth, and indicate the patient's status at the time of treatment. Ensure to check the appropriate box for military service member, retired military service member, or dependent.
3. In Section I, provide vital information such as the service number, branch of service, and social security number for the patient. Fill out the information for any dependents if applicable.
4. Proceed to Section IB, where you will specify the information and/or documents you are requesting. Clearly identify treatment dates and the name and location of the military facility where treatment was received.
5. Complete the information needed to locate records. Fill in applicable treatment dates, nature of illness or injury, and any previous facilities where outpatient treatment occurred.
6. Move to Section II – Return Address and Signature. Identify yourself as the requester and provide your name, signature, email address, and other contact information. Ensure to include the relationship if you are a legal guardian or next of kin.
7. Sign the authorization statement in Section II, confirming the accuracy of the information provided under penalty of perjury. Ensure all required signatures are completed before submission.
8. After completing the form, carefully review all entries for accuracy. Once verified, save the changes, and you can download, print, or share the completed form as needed.

Start filling out your NA Form 13042 online today to ensure a smooth and efficient request process.