Formulaire

Request for State Medical Assistance (AME) (Form 11573*09)

Cerfa 11573*09 (S3720h)

Contains a package leaflet (50741#09), indicating in particular the documents to be provided.

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    Émetteur du formulaire administratif : National Health Insurance Fund (Cnam)

    Verified 18 February 2022 - Directorate for Legal and Administrative Information (Prime Minister)