Attending physician and coordinated care pathway
Verified 07 July 2023 - Legal and Administrative Information Directorate (Prime Minister)
What is the role of the attending physician in the coordinated care pathway? It consists in being entrusted with the coordination of care for your medical follow-up. You choose your primary care physician. By consulting your attending physician, you enter the care path. This way you get a better refund. Indeed, your attending doctor is for the Health Insurance your 1er contact for your health.
You can choose freely your treating doctor. He must agree to fulfill this role. .
For children under 16 years of age, at least one of the two parents (or holder of parental authority) chooses the attending physician.
The treating physician may be:
- General Practitioner
- Specialist
- Agreed sector 1 (no fee overrun)
- Agreed Sector 2 (possible fee overrun)
Please note
It is possible to know which area his doctor is responsible for by going to theAmeli's directory.
He may exercise:
- Alone
- Within a group firm
- In a health center
- In a hospital.
It can be located in the place that suits you best (near your home, or work...).
FYI
If the doctor refuses or you cannot find a doctor, you can contact the conciliator of your primary health insurance fund (CPAM).
Répondez aux questions successives et les réponses s’afficheront automatiquement
Online by the doctor
The doctor may offer to make the declaration via the Internet.
He'll need your vital card.
By mail
You have to fill out a declaration form with the doctor you have chosen, for example during a consultation.
The doctor has to sign this form.
The form leaflet explains how to fill in the sections.
Once completed, the form is to be sent to your health insurance organization.
Declare your treating physician
Your statement remains valid as long as you and your doctor agree to continue this patient/physician relationship.
You are free to change the attending physician when you wish and without proof.
To declare your new attending physician, the procedure is the same as for the designation.
Your new return cancels the previous one.
You do not have to tell your previous doctor. However, this information can facilitate its organization.
The primary tasks of the attending physician are to:
- Ensure a 1er level of use of care and coordination of medical follow-up
- Guide you through the coordinated care journey
- Establishing a care protocol for a long-term disorder
- Ensure personalized prevention (vaccination, health advice according to your lifestyle...).
FYI
The treating physician can access the data integrated by the healthcare professionals in My health space if you opened it.
The coordinated care pathway consists of consulting priority your doctor treating you for medical follow-up.
If you go to a doctor who you haven't declared as a primary care physician, you get less money back except in a few situations (examples: you are under 16 years old, you are far from home, you consult urgently).
In addition to consultation to your treating doctorHowever, other consultations are part of the care pathway.
Indeed, you are in the coordinated care path if you consult one of the following doctors :
- Your doctor’s replacement
- Another doctor, says correspondent doctor, at the request of your treating doctor
- A doctor in case of emergency
- A doctor when you are far from home
- A gynecologist, ophthalmologist, psychiatrist, or stomatologist
- A doctor in the hospital for a substance abuse problem (alcohol, tobacco, drugs)
- A doctor in a humanitarian medicine facility
- A doctor at a family planning or education center
- General practitioner settled less than 5 years ago
- A general practitioner working in a health center in an area lacking health care
- A doctor following a diagnosis of a genetic defect in a member of your family.
You're refunded normally even if you consult them without going through your doctor.
Who can help me?
Find who can answer your questions in your region
- Primary health insurance fund (CPAM)
- Health Info Rights
A telephone line created by a collective of user associations to provide legal or social information related to health
By telephone
01 53 62 40 30
Price of a local call
Open Service:
- Monday, Wednesday and Friday from 2pm to 6pm,
- tuesdays and thursdays from 2pm to 8pm
By Form
You can also ask your question by completing the contact form ;
From this form, you can request to be called back.
- Social Security Code: Articles L162-5 to L162-5-4Coordinated care pathway and designation of the treating physician (Articles L162-5 and L162-5-3)
- Social Security Code: Articles L162-24-1 to L162-30-5Tariff increase in case of consultation of a hospital specialist without prior prescription of the treating doctor (Article L162-26)
- Social Security Code: Articles D162-1-6 to D162-1-8Exceptions to the application of the user fee surcharge
- Order of 20 October 2016 approving the national convention on the organization of relations between liberal doctors and health insurance signed on 25 August 2016
- Declare your treating physician
Form
- Ameli Online
Online service
- Reimbursement of care by Social SecurityService-Public.fr
- Complementary health (mutual) and complementary health solidarityService-Public.fr
- Reimbursement for a medical consultationService-Public.fr
- Reimbursement of a medical consultation for a childService-Public.fr
- User ticket, package and deductibles (Social security)Service-Public.fr
- The Coordinated Care PathwayNational Health Insurance Fund (Cnam)
- Choosing and reporting your treating physicianAmeli.fr
- Health Directory - Ameli SiteNational Health Insurance Fund (Cnam)