First health certificate (Form 12596*03)
Ministry of Health - Cerfa n° 12596*03
It must be completed during the mandatory preventive examination within 8 days of birth. The family completes the administrative part of the certificate and the doctor completes the medical part, stamps it, signs it and sends it.
Go to the online administrative form
Verified 07 February 2020 - Directorate for Legal and Administrative Information (Prime Minister)
To whom shall I send this form ?
To be addressed to the head of the department's Maternal and Child Protection department
Maternal and Child Protection Center (PMI)
For details, please use the practical information sheets :
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