Request for prior transport agreement - medical prescription for transport (Form 11575*07)

National Health Insurance Fund (Cnam) - Cerfa n° 11575*07
Autre numéro : S3139g

Form template uploaded for information

For your gait, you must use the original form provided by the healthcare professional.

Go to the online administrative form

Verified 24 October 2023 - Directorate for Legal and Administrative Information (Prime Minister)

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