Cerfa 12267*06 (S3125) — Soins reçus à l'étranger : déclaration à compléter par l'assuré(e)

What is Cerfa 12267 - care received abroad (S3125)?

If you are covered by French health insurance (Assurance Maladie) and pay for medical care during a stay abroad — on holiday, studying, or posted by your employer — you can ask your caisse primaire d'assurance maladie (CPAM) to refund it. Cerfa 12267, also known by its Assurance Maladie reference S3125, is the claim form, sent with the original receipted invoices.

On one page it asks who received the care and who is insured, the insured person's nationality, address and situation, the stay abroad and why care was needed, what it was related to (illness, long-term condition, maternity, accident at work, accident caused by a third party), each kind of care with the amount paid, and — for care in the EU, EEA, Switzerland or the UK — whether you want the French or the local tariff. The back is the notice.

FileIt turns Cerfa 12267 into a guided form and prints your answers into the official PDF (12267*06). It checks social security numbers and their keys, splits them into the form's boxes, writes the currency after every amount and checks the total adds up. The finished PDF is saved in your vault; you print it, sign it and post it to your CPAM.

Who needs to fill out Cerfa 12267 - care received abroad (S3125)?

• Someone who saw a doctor, went to hospital or bought medicines on holiday abroad and paid on the spot.
• A parent claiming for a child who fell ill during a trip.
• A student or intern abroad, or an employee posted abroad by their employer.
• A Swiss cross-border worker covered in France.
• Someone who had an accident abroad, including one caused by a third party.

When to use Cerfa 12267 - care received abroad (S3125)

• After you paid for care abroad and have the receipted invoices.
• For care in the EU, EEA, Switzerland or the UK that you paid yourself rather than with your European Health Insurance Card.
• For care elsewhere in the world, where your CPAM decides whether and how much it can refund.

What you need before you start

• The original receipted invoices for all the care (service-public.fr and the form both ask for them).
• The medical prescriptions for the care received — the form marks pharmacy, laboratory, physiotherapy, nursing, other care and transport with an asterisk.
• Proof of payment, such as a card receipt, a bank statement showing the debit, or a transfer.
• If you were posted abroad, the posting form validated by your caisse.
• The social security numbers of the person treated and of the insured person.
• The address and dates of your stay, and the amounts you paid, in the currency you paid in.

What’s on Cerfa 12267 - care received abroad (S3125)

The 2026 edition has 2 pages. FileIt asks for it in 8 parts:

1. The person who received the care (personne ayant reçu les soins)Insured person (assuré(e))
2. Nationality and usual address of the insured person (nationalité et adresse habituelle de l'assuré(e))Insured person (assuré(e))
3. The insured person's situation on the date of the care (situation administrative)Insured person (assuré(e))
4. The stay abroad (caractéristiques du séjour à l'étranger)Insured person (assuré(e))
5. What the care was related to (les soins reçus sont en rapport avec)Insured person (assuré(e))
6. The care and what you paid (le détail des soins)Insured person (assuré(e))
7. Medically necessary care received in the EU / EEA / Switzerland / United KingdomInsured person (assuré(e))
8. Sworn statement by the insured person (attestation sur l'honneur)Insured person (assuré(e))

How to fill out Cerfa 12267 - care received abroad (S3125), step by step

1 The person who received the care and the insured person

Name (birth name followed by any name in use), social security number with its key and date of birth of the person treated; if they are not the insured person, the insured person's name and number too.

2 Nationality, address and situation

The insured person's nationality (French, EU/EEA/Swiss, UK case 1 or 2, or other), usual address and e-mail, and their situation on the date of the care: employee, self-employed, invalidity pension or AT/MP annuity, retired, student, unemployment benefit, Swiss cross-border worker or other.

3 The stay abroad

Address, town and country during the stay, its dates, the reason for the stay (tourism, posting, studies or other), and why care was needed — a fall, an injury, an emergency, surgery, chronic care.

4 What the care was related to

An illness, a long-term condition (ALD), maternity, an accident at work or occupational disease (with its date), a condition of military origin, or an accident caused by a third party (with its date), and whether the care was planned before you left.

5 The care and what you paid

Tick each kind of care — doctor (surgery or home visit, GP or specialist), dental care, prosthesis, outpatient surgery, pharmacy, laboratory, radiology, physiotherapy, nursing, other care, hospitalisation with its dates, transport — and give the amount paid for each, with the currency.

6 EU / EEA / Switzerland / UK and the sworn statement

For care in those countries, choose the tariff (the country of the stay or France) and say whether any of it was refunded there. Then certify the total amount paid, and give the place and date.

Common mistakes to avoid

• Sending copies instead of the original receipted invoices.
• Forgetting the prescriptions for the items marked with an asterisk.
• Leaving out the currency of the amounts.
• A total that doesn't match the amounts listed for each kind of care.
• Forgetting to date and sign the form — the notice reminds you to before sending it.

After you fill it out

Print the PDF, date and sign it by hand (or tick that the insured person cannot sign).

Post it with the original invoices, prescriptions and proof of payment to your caisse primaire d'assurance maladie. Keep a photocopy of the whole file for your mutuelle or other top-up insurer, as the form advises. FileIt doesn't send it.

The filled form stays in your FileIt vault with your travel documents.

Cerfa 12267 - care received abroad (S3125): frequently asked questions

Official sources

• Blank form (PDF), published by Assurance Maladie (caisse primaire d'assurance maladie, CPAM): https://www.formulaires.service-public.fr/gf/cerfa_12267.do
• Official instructions and guidance: https://www.service-public.gouv.fr/particuliers/vosdroits/R17466
• Edition shown on this page: 12267*06 (S 3125e) (checked 2026-10-25).

FileIt is not affiliated with or endorsed by Assurance Maladie (caisse primaire d'assurance maladie, CPAM) or any government. This page explains the form in general terms and is not legal, tax or immigration advice. Always read the official instructions, and check that you are using the edition the recipient accepts. Page last reviewed 2026-10-25.

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