Formulaire

Medical Certificate - Request for Specific Information in the Event of an Electrical Blackout (Form 10402*02)

Ministry of Health - Cerfa n° 10402*02

Form concerning high-risk-of-life (HRV) patients who are the subject of a special information service in the event of an electrical power cut-off.

Medical certificate to be attached to the cerfa form n°10401*02 to request access to a particular information service set up for high-risk vital patients treated at home, in case of a planned or unexpected cut-off to the electricity network.

Contains instructions for use.

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    J'ai réalisé une démarche administrative

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    Émetteur du formulaire administratif : Directorate for Legal and Administrative Information

    Verified 25 February 2020 - Directorate for Legal and Administrative Information (Prime Minister)