Formulaire

Bizonal Order (Form 14465*01)

Cerfa 14465*01 (S3321b)

Special prescription, used by the doctor to distinguish between medicines and tests related to your long-term condition (ALD) and taken care of 100% and those related to other diseases, supported at the usual reimbursement rates.

Form template uploaded for information.

    Fill out the form

    To whom shall I send this form ?

    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.

    Je donne mon avis

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

    Verified 10 February 2020 - Directorate for Legal and Administrative Information (Prime Minister)