Medical prescription for transport (Form 11574*06)
National Health Insurance Fund (Cnam) - Cerfa n° 11574*06
Autre numéro : S3138g
Form template (specimen) uploaded for information.
The original form must be used for your application.
The form contains an information leaflet n°50742#06.
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Verified 11 October 2022 - Directorate for Legal and Administrative Information (Prime Minister)
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