Care Sheet - Physician (Specimen) (Form 12541*02)

National Health Insurance Fund (Cnam) - Cerfa n° 12541*02
Autre numéro : S3110j

Form template uploaded for information. For your gait, you must use the original form submitted by your doctor (except for the Vitale teletransmission).

The form contains leaflet n°51070#02.

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Verified 01 April 2020 - Directorate for Legal and Administrative Information (Prime Minister)

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