Formulaire
Request for prior transport agreement - medical prescription for transport
Cerfa 11575*08 (S3139h)
Form template posted online for information
For your approach, you must use the original form provided by the health professional.
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.
Émetteur du formulaire administratif : National Health Insurance Fund (Cnam)
Verified 12 August 2026 - Public Service / (Prime Minister)