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Na form 13055 2026
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- Click ‘Get Form’ to open the na form 13055 in the editor.
- Begin by entering the 'Name of Patient Used at Time of Treatment'. This is crucial for identifying the correct medical records.
- Next, specify the 'Nature of Illness, Injury or Treatment'. Be as detailed as possible to assist in locating relevant records.
- Fill in the 'Service No.' and provide treatment dates in the 'Treatment Dates From' and 'To' fields. Ensure you include exact months and years.
- Indicate whether the treatment was 'In-Patient' or 'Out-Patient' by checking the appropriate box.
- Complete details about your branch of service and organization assigned, including specific units.
- Provide the name and location of the hospital or medical facility where treatment occurred.
- Finally, ensure that you sign under 'Release Authorization', providing your contact information for follow-up.
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