Formulaire
Bizonal Order (Form 14465*01)
National Health Insurance Fund (Cnam) - Cerfa n° 14465*01
Autre numéro : S3321b
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
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.
Émetteur du formulaire administratif : Directorate for Legal and Administrative Information
Verified 10 February 2020 - Directorate for Legal and Administrative Information (Prime Minister)