Prescription of drugs or products and exception benefits (Form 12708*02)

National Health Insurance Fund (Cnam) - Cerfa n° 12708*02
Autre numéro : S3326b

A prescription used to prescribe a drug, product, or benefit for which reimbursement is subject to a special formality.

The form contains an explanatory note.

Form template uploaded for information. To establish the prescription, your doctor will use the form provided by the health insurance organization.

Go to the online administrative form

Verified 28 January 2020 - Directorate for Legal and Administrative Information (Prime Minister)

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For details, please use the practical information sheets :

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