Formulaire
Prescription of drugs or products and exception benefits (Form 12708*02)
Cerfa 12708*02 (S3326b)
A prescription used to prescribe a drug, product, or benefit for which reimbursement is subject to a special formality.
The form contains an explanatory note.
Form template uploaded for information. To establish the prescription, your doctor will use the form provided by the health insurance organization.
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 : National Health Insurance Fund (Cnam)
Verified 28 January 2020 - Directorate for Legal and Administrative Information (Prime Minister)