Get Formulaire 201

Filling out the Formulaire 201 is essential for healthcare professionals seeking a professional health card. This guide provides clear instructions to help users of all experience levels complete the form accurately and efficiently online.

Follow the steps to complete the Formulaire 201 online.

1. Click the ‘Get Form’ button to obtain the Formulaire 201 and open it in your preferred online editor.
2. Enter the contract number for the structure, if available. This will assist in identifying your request and linking it to the appropriate records.
3. Provide identifying details for the structure, including the FINESS number or SIRET number, and the name of the structure responsible for this request.
4. Identify the representative (if applicable), completing the selection for gender, full name, and other personal information such as the ADELI number, email address, preferred spoken languages, and contact number.
5. If the activity differs from that of the subscriber, fill in the corresponding FINESS or SIRET number and structure name again in this section to clarify.
6. Confirm your role as a legal representative of the structure and answer the associated questions regarding the sending of electronic care sheets and management of cards.
7. Fill in the delivery address, ensuring that you provide complete details such as the street name, number, postal code, and city, as this will be used to send your health card.
8. Certify the accuracy of the provided information by checking the designated box. Note that submitting false information may lead to legal consequences.
9. Finally, sign and date the form where indicated, making sure to include the name and title of the legal representative if applicable.
10. Once all sections are completed, you can save changes, download the filled-out form, print it, or share it as needed.

Complete your Formulaire 201 online today for a streamlined process!