Formulaire

Request for prior approval (Health insurance, maternity, accident at work, occupational disease)

Cerfa 12040*04 (DIAD S3108f)

Form template posted online for information

For your approach, you must use the original form provided by the health professional.

Contains an explanatory note n°50556#05.

    Fill out the form

    To whom shall I send 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 04 November 2026 - Public Service / (Prime Minister)