NA Form 13042 at a glance
What it is: Request for Information Needed to Locate Medical Records (NA Form 13042): use this form to request categories of medical records from the National Personnel Records Center.
Who signs: Sign for Signature of patient, next of kin, or legal guardian. Do not print. Others requesting information must have the release authorization in Section II signed by the patient or legal guardian.
When to use this form: clinical (inpatient) records for a military service member, a military retiree, or a dependent of an active/retired military member for hospitalization in a military medical treatment facility.
When to use this form: outpatient records for a military retiree, a dependent of an active/retired military member, a civilian Federal employee, or a dependent of a civilian employee for outpatient treatment in a military medical treatment facility.
A filled-in NA Form 13042 example: a retiree requests inpatient records
How to fill out NA Form 13042, box by box
About the patient
In Section I, About the Patient, enter the Name of Patient: Last, First, Middle Initial and Date of Birth.
Status of patient at time of treatment
Under Status of Patient at Time of Treatment, check the appropriate box and fill in the information requested on the blank lines.
For Military Service Member, fill in SSN, Branch of service and Service Number.
For Retired Military Service Member, fill in SSN, Branch of service, Service Number and Date Retired.
For Dependent of Military Service Member, fill in the Sponsor's Name (last, first, middle initial), SSN, Branch of service and Service Number.
For Federal Employee or Dependent of Federal Employee, fill in the Employee's Name (last, first, middle initial), SSN, Date of Birth and Separation Date.
Information and documents requested, and where treatment was received
Under B, Information and/or Documents Requested, enter the information or documents you request.
Under C, Information Needed to Locate Records, complete the applicable lines only for the records you are requesting.
For Inpatient Records, enter the Name & Location of Military Facility Where Treatment Was Received, the Treatment Dates From Mo/Yr and To Mo/Yr, and the Nature of Illness, Injury, or Treatment.
For Outpatient Records, enter the Name & Location of the Last Military Facility Providing Outpatient Treatment for Any Condition, the Last Year Treated for Any Outpatient Condition, and optionally the Location & Year for Outpatient Treatment at a Previous Facility, which may help locate records that did not transfer.
Requester is
In Section II, for 1. Requester Is, mark Patient identified in Section 1A, Next of kin of deceased patient (must provide proof of death) and show relationship, Parent of minor dependent or legal guardian of patient (if guardian, submit a copy of court appointment), or Other (specify).
The next of kin is defined as any of the following: unremarried surviving spouse, father, mother, son, daughter, sister, or brother.
The next of kin must provide proof of death and show relationship; the legal guardian must provide a copy of the court order proving guardianship or mental incompetence, as appropriate.
Signature
You declare under penalty of perjury under the laws of the United States of America that the information in Section II is true and correct.
Sign for Signature of patient, next of kin, or legal guardian. Do not print.
Enter the E-mail address and the Date.
Send information and documents to
Please print or type.
Under 3. Send Information/Documents To, enter the Name and the Street.
Enter the City, State and ZIP Code.
Enter the Daytime phone number (including area code).
The reply may be sent to the patient or any other address designated by the patient or other authorized requester.
More rules for NA Form 13042
Fill in page 2 of this form to the best of your ability.
Be sure to read the section near the bottom entitled "Authorization to Receive Information from Medical Records" and obtain the required authorization signature.
The former patient or the patient's legal guardian has access to almost any information contained in the patient's own record.
Release of information is subject to restrictions imposed by the military services and civilian agencies consistent with Department of Defense and civilian agency regulations and the provisions of the Freedom of Information Act (FOIA) and the Privacy Act of 1974.
If the patient is deceased, surviving next of kin may, under certain circumstances, be entitled to these records as well.
Common questions about NA Form 13042
Where do I file it?
Where to send this form: National Personnel Records Center, Military Personnel Records, 1 Archives Drive, St. Louis, MO 63138-1002.
When is this form not the right one?
Do not use this form to request outpatient (health) records and dental records created for a person while in the military service. Request these records by using Standard Form (SF) 180, Request Pertaining to Military Records. When not to use this form: VA hospital records. Phone the VA at 1-800-827-1000 for help in obtaining these records. You will need to provide your VA Claim Number.
Sources
[1] NA Form 13042 (REV. 09/25), Request for Information Needed to Locate Medical Records, National Archives and Records Administration (the Official source link on this page).