Third health certificate (Form 12598*05)

Ministry of Health - Cerfa n° 12598*05

To be completed during the mandatory preventive examination on 24e month. The family completes the administrative part of the certificate and the doctor completes the medical part, stamps it, signs it and sends it.

Go to the online administrative form

Verified 12 October 2020 - Directorate for Legal and Administrative Information (Prime Minister)

To whom shall I send 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.

Je donne mon avis