Medical prescription for large appliances (Form 12042*02)

National Health Insurance Fund (Cnam) - Cerfa n° 12042*02
Autre numéro : S3135b

Form template uploaded for information.

For your gait, you must use the original form provided by the healthcare professional.

The form contains a leaflet n°50561#03.

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Verified 08 April 2020 - Directorate for Legal and Administrative Information (Prime Minister)

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