Care received abroad - Declaration to be completed by the insured (Form 12267*06)
National Health Insurance Fund (Cnam) - Cerfa n° 12267*06
Autre numéro : S3125e
Allows you to submit your refund request (with proof) to your cash register if you received treatment during a stay abroad.
Go to the online administrative form
Verified 14 June 2024 - Directorate for Legal and Administrative Information (Prime Minister)
To whom shall I send this form ?
Contact the entity in charge of this form
For details, please use the practical information sheets :
J'ai réalisé une démarche administrative
Je donne mon avis sur Services Publics +. L'administration concernée me répondra.