Request for Prior Approval - Medical Biology Examinations (Form 10128*04)

National Health Insurance Fund (Cnam) - Cerfa n° 10128*04
Autre numéro : S3132c

Form to be filled in for all acts of the nomenclature of medical biological acts subject to the obligation of prior agreement.

  • Strands 1 and 3: to be sent prior to the execution of the acts to the medical service of the sickness insurance body on which the insured person depends
  • Strand 2: to be kept by the insured

Access to package leaflet n°50053*04.

Go to the online administrative form

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

To whom shall I send this form ?

Contact the entity in charge of this form

J'ai réalisé une démarche administrative

Je donne mon avis sur Services Publics +. L'administration concernée me répondra.

Je donne mon avis