Formulaire

Care Protocol (Form 11626*07)

Cerfa 11626*07 (S3501g)

Printed by your treating doctor if you have a long-term condition or if your condition requires an interruption of work or continuous care for more than 6 months.

The print-out informs you about the conditions for taking care of your illness.

You should present it to the doctors you will see.

The form contains a package leaflet for the doctor and a package leaflet for the patient.

    Fill out the form

    Contact the entity in charge of this form

    For details, please use the practical information sheets :

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

    Verified 04 April 2022 - Directorate for Legal and Administrative Information (Prime Minister)