Formulaire

Application for approval of an association of users of the health system - Form A (Form 12623*02)

Cerfa 12623*02

Allows an association or union of associations to apply for national or regional approval for its action in the field of quality of care and patient care.

Does not allow for the renewal of a license.

For associations, this application must be supplemented by a form B for each association affiliated to the union.

    Fill out the form

    To whom shall I send this form ?

    • For national accreditation

      Directorate of Legal Affairs (Daj)

      By email: daj-agrément@sg.social.gouv.fr

    • For regional approval

      Regional Health Agency (RHA)

    Download Approval certificate for an association member of a union - Sheet B

    FACULTATIF - This sheet B is intended to supplement the application for approval of a union of associations of users of the health system and must be completed by each association affiliated to the union. : 

    PDF - 1.5 MB

    Formulaire annexe

    For details, please use the practical information sheets :

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    Émetteur du formulaire administratif : Ministry of Health

    Verified 20 December 2023 - Directorate for Legal and Administrative Information (Prime Minister)