Formulaire

Care Record - Care Received Abroad by Posted Employee (Form 11790*01)

Cerfa 11790*01 (S3124a)

Relates to an employee posted to a country outside Europe.

Must be accompanied by originals of invoices paid by the insured and medical prescriptions.

    Fill out the form

    To whom shall I send 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.

    Je donne mon avis

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

    Verified 15 February 2021 - Directorate for Legal and Administrative Information (Prime Minister)