Care Protocol (Form 11626*07)
National Health Insurance Fund (Cnam) - Cerfa n° 11626*07
Autre numéro : S3501g
Printed by your treating doctor if you have a long-term condition or if your condition requires an interruption of work or continuous care for more than 6 months.
The print-out informs you about the conditions for taking care of your illness.
You should present it to the doctors you will see.
The form contains a package leaflet for the doctor and a package leaflet for the patient.
Go to the online administrative form
Verified 04 April 2022 - Directorate for Legal and Administrative Information (Prime Minister)
Contact the entity in charge of this form
For details, please use the practical information sheets :
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