Na form 13042 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section I, which requires information about the patient. Enter the patient's last name, first name, and middle initial as requested.
3. Indicate the status of the patient at the time of treatment by checking the appropriate box and providing any necessary service numbers or dates.
4. In Section B, specify the information and/or documents you are requesting. Be clear and concise to ensure accurate processing.
5. Complete Section C by providing details needed to locate records, including nature of illness or treatment dates. This helps streamline your request.
6. Move to Section II for your return address and signature. Ensure that you sign where indicated and provide a valid email address for correspondence.

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