Formulaire
Medical prescription for large equipment
Cerfa 12042*02 (S3135b)
Form template posted online for information.
For your approach, you must use the original form provided by the health professional.
The form contains a user manual n°50561#03.
For details, please use the practical information sheets :
J'ai réalisé une démarche administrative
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Émetteur du formulaire administratif : National Health Insurance Fund (Cnam)
Verified 04 November 2026 - Public Service / (Prime Minister)