Brown form from Doctor Cerfa 12541*01


I have a couple of the forms (blank attached) from the doctor to confirm payment prior to receiving my Carte Vitale.

Apparently I can send them away for partial reimbursement - any idea where to send them?

We live in 33570 Puisseguin so would it be an office in Livourne or Bordeaux perhaps?


cerfa-12541-02-feuille-de-soins-medecin.pdf (364.4 KB)

If you go onto the Ameli website and put your postcode in, it will tell you the relevant CPAM address. (You will need to put your immatriculation number in the form though)

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You send the form to your caisse d’assurance maladie (CPAM) dependant upon where you live and as @Mark_Robbins says, in your Ameli account in «Mes informations» it tells you the name of your caisse. Click on the arrow next to it and it brings up another page giving all the contact details - click on «par courrier» and you will see the address of your caisse (dependant on where you live).

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I haven’t checked recently, as website has changed. But you used to be able to scan them and attach them to a message, and send them that way.

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