Formulaire

Request for specific information in the event of a power failure (Form 10401*02)

Cerfa 10401*02

Allows you to request access to a specific information service for high-risk patients treated at home in the event of a planned or unexpected power outage.

Contains cerfa No. 50184#02 package leaflet.

    Fill out the form

    To whom shall I send this form ?

    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 : Ministry of Health

    Verified 17 March 2023 - Directorate for Legal and Administrative Information (Prime Minister)