Care Sheet - Pharmacist (Specimen) (Form 11389*05)

National Health Insurance Fund (Cnam) - Cerfa n° 11389*05
Autre numéro : S3115h

Form template uploaded for information. For your gait, you must use the original form submitted by your doctor (except for the Vitale teletransmission).

The form contains leaflet n°50652#05.

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Verified 01 April 2020 - Directorate for Legal and Administrative Information (Prime Minister)

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