Bizonal Order (Form 14465*01)

National Health Insurance Fund (Cnam) - Cerfa n° 14465*01
Autre numéro : S3321b

A special prescription, used by the doctor to distinguish between medicines and tests related to your long-term condition (ALD), and taken care of 100% and those related to other diseases, supported at the usual reimbursement rates.

Form template uploaded for information.

Go to the online administrative form

Verified 10 February 2020 - Directorate for Legal and Administrative Information (Prime Minister)

To whom shall I send this form ?

Contact the entity in charge of 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.