{"id":149,"date":"2021-06-16T07:10:24","date_gmt":"2021-06-16T06:10:24","guid":{"rendered":"https:\/\/mes-formulaires.cpamcentre.fr\/?page_id=149"},"modified":"2021-06-18T13:19:12","modified_gmt":"2021-06-18T12:19:12","slug":"je-change-de-situation-old","status":"publish","type":"page","link":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/je-change-de-situation-old\/","title":{"rendered":"Je change de situation [OLD]"},"content":{"rendered":"<p style=\"text-align: justify;\">Afin de faciliter nos \u00e9changes, nous vous proposons de compl\u00e9ter les formulaires ci-dessous en indiquant les informations relatives \u00e0 votre changement de situation.<\/p>\n<p style=\"text-align: justify;\">Pensez \u00e9galement \u00e0 faire les d\u00e9marches n\u00e9cessaires aupr\u00e8s des autres organismes (URSSAF, Conseil de l&rsquo;Ordre&#8230;).<\/p>\n<p style=\"text-align: justify;\">Cliquez sur la situation concern\u00e9e :<\/p>\n<hr>\n<div id=\"accordion-1\" class=\"accordion no-js\"><\/p>\n<p>\n\t\t\t\t\t<h2 role=\"button\" id=\"accordion-1-t1\" class=\"accordion-title js-accordion-controller\" aria-controls=\"accordion-1-c1\" aria-expanded=\"false\" tabindex=\"0\">\n\t\t\t\t&gt; Je change d'adresse\t\t\t<\/h2>\n\t\t\n\t\t<div id=\"accordion-1-c1\" class=\"accordion-content\" aria-hidden=\"true\">\n\t\t\t<br \/>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f123-o1\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"123\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/149#wpcf7-f123-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"123\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f123-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<table border=0 padding=0 margin=0>\n\t<tr>\n\t\t<td>\n\t\t\t<h4>Mes informations\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Profession*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Profession\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Profession\"><option value=\"Dentiste\">Dentiste<\/option><option value=\"Directeur de laboratoire\">Directeur de laboratoire<\/option><option value=\"Fournisseur\">Fournisseur<\/option><option value=\"Infirmier\">Infirmier<\/option><option value=\"Masseur-kin\u00e9sith\u00e9rapeute\">Masseur-kin\u00e9sith\u00e9rapeute<\/option><option value=\"M\u00e9decin\">M\u00e9decin<\/option><option value=\"Orthophoniste\">Orthophoniste<\/option><option value=\"Orthoptiste\">Orthoptiste<\/option><option value=\"Pharmacien\">Pharmacien<\/option><option value=\"Podologue\">Podologue<\/option><option value=\"Sage-femme\">Sage-femme<\/option><option value=\"Transporteur\">Transporteur<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>N\u00b0 Identification Assurance Maladie (41...)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NumAM\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"NumAM\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Nom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Pr\u00e9nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Prenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Prenom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Adresse mail*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"Mail\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>J'accepte que mon adresse mail soit utilis\u00e9e par la CPAM<br \/>\nde Loir-et-Cher \u00e0 des fins d'information me concernant :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"UtilisationEmail\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"UtilisationEmail\" value=\"Oui\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"UtilisationEmail\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<h4>Mon changement d'adresse\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Le changement concerne mon adresse :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"TypeAdresse\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"TypeAdresse\" value=\"professionnelle\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">professionnelle<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"TypeAdresse\" value=\"personnelle\" \/><span class=\"wpcf7-list-item-label\">personnelle<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Date d'effet (jj\/mm\/aaaa)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"DateEffet\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"DateEffet\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Nouvelle adresse*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NouvelleAdresse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"NouvelleAdresse\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Code postal*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CP\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"CP\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Ville*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Ville\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Ville\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Votre num\u00e9ro de t\u00e9l\u00e9phone change-t-il \u00e9galement ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NvTel\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"NvTel\" value=\"Oui\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"NvTel\" value=\"Non\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Si oui, nouveau t\u00e9l\u00e9phone<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NvTelephone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"NvTelephone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p>&nbsp;\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p align=center><i>Pensez \u00e9galement \u00e0 en informer le Conseil de l'Ordre D\u00e9partemental.<\/i>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<table>\n\t\t<tr>\n\t\t\t<td>\n\t\t\t\t<p><b>Merci de saisir le code affich\u00e9 ci-dessous pour valider votre envoi : <\/b><br \/>\n<input type=\"hidden\" name=\"_wpcf7_captcha_challenge_captcha-170\" value=\"1343215250\" \/><img decoding=\"async\" class=\"wpcf7-form-control wpcf7-captchac wpcf7-captcha-captcha-170\" width=\"72\" height=\"24\" alt=\"captcha\" src=\"https:\/\/mes-formulaires.cpamcentre.fr\/wp-content\/uploads\/wpcf7_captcha\/1343215250.png\" \/><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"captcha-170\"><input size=\"4\" maxlength=\"4\" class=\"wpcf7-form-control wpcf7-captchar\" autocomplete=\"off\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"captcha-170\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t<\/table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p align=center><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"133\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<br \/>\n\t\t<\/div>\n\n\t\t<\/p>\n<p>\n\t\t\t\t\t<h2 role=\"button\" id=\"accordion-1-t2\" class=\"accordion-title js-accordion-controller\" aria-controls=\"accordion-1-c2\" aria-expanded=\"false\" tabindex=\"0\">\n\t\t\t\t&gt; Je change de num\u00e9ro &nbsp;de t\u00e9l\u00e9phone\t\t\t<\/h2>\n\t\t\n\t\t<div id=\"accordion-1-c2\" class=\"accordion-content\" aria-hidden=\"true\">\n\t\t\t<br \/>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f146-o2\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"146\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/149#wpcf7-f146-o2\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"146\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f146-o2\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<table border=0 padding=0 margin=0>\n\t<tr>\n\t\t<td>\n\t\t\t<h4>Mes informations\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Profession*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Profession\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Profession\"><option value=\"Dentiste\">Dentiste<\/option><option value=\"Directeur de laboratoire\">Directeur de laboratoire<\/option><option value=\"Fournisseur\">Fournisseur<\/option><option value=\"Infirmier\">Infirmier<\/option><option value=\"Masseur-kin\u00e9sith\u00e9rapeute\">Masseur-kin\u00e9sith\u00e9rapeute<\/option><option value=\"M\u00e9decin\">M\u00e9decin<\/option><option value=\"Orthophoniste\">Orthophoniste<\/option><option value=\"Orthoptiste\">Orthoptiste<\/option><option value=\"Pharmacien\">Pharmacien<\/option><option value=\"Podologue\">Podologue<\/option><option value=\"Sage-femme\">Sage-femme<\/option><option value=\"Transporteur\">Transporteur<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>N\u00b0 Identification Assurance Maladie (41...)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NumAM\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"NumAM\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Nom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Pr\u00e9nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Prenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Prenom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Adresse mail*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"Mail\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>J'accepte que mon adresse mail soit utilis\u00e9e par la CPAM<br \/>\nde Loir-et-Cher \u00e0 des fins d'information me concernant :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"UtilisationEmail\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"UtilisationEmail\" value=\"Oui\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"UtilisationEmail\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<h4>Mon changement de t\u00e9l\u00e9phone\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>T\u00e9l\u00e9phone actuel*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"TelActuel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"TelActuel\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Nouveau t\u00e9l\u00e9phone*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NvTel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"NvTel\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p>&nbsp;\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p align=center><i>Pensez \u00e9galement \u00e0 en informer le Conseil de l'Ordre D\u00e9partemental.<\/i>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<table>\n\t\t<tr>\n\t\t\t<td>\n\t\t\t\t<p><b>Merci de saisir le code affich\u00e9 ci-dessous pour valider votre envoi : <\/b><br \/>\n<input type=\"hidden\" name=\"_wpcf7_captcha_challenge_captcha-170\" value=\"1020714920\" \/><img decoding=\"async\" class=\"wpcf7-form-control wpcf7-captchac wpcf7-captcha-captcha-170\" width=\"72\" height=\"24\" alt=\"captcha\" src=\"https:\/\/mes-formulaires.cpamcentre.fr\/wp-content\/uploads\/wpcf7_captcha\/1020714920.png\" \/><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"captcha-170\"><input size=\"4\" maxlength=\"4\" class=\"wpcf7-form-control wpcf7-captchar\" autocomplete=\"off\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"captcha-170\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t<\/table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p align=center><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_2\" name=\"_wpcf7_ak_js\" value=\"9\"\/><script>document.getElementById( \"ak_js_2\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<br \/>\n\t\t<\/div>\n\n\t\t<\/p>\n<p>\n\t\t\t\t\t<h2 role=\"button\" id=\"accordion-1-t3\" class=\"accordion-title js-accordion-controller\" aria-controls=\"accordion-1-c3\" aria-expanded=\"false\" tabindex=\"0\">\n\t\t\t\t&gt; Je change d'adresse email\t\t\t<\/h2>\n\t\t\n\t\t<div id=\"accordion-1-c3\" class=\"accordion-content\" aria-hidden=\"true\">\n\t\t\t<br \/>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f125-o3\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"125\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/149#wpcf7-f125-o3\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"125\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f125-o3\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<table border=0 padding=0 margin=0>\n\t<tr>\n\t\t<td>\n\t\t\t<h4>Mes informations\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Profession*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Profession\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Profession\"><option value=\"Dentiste\">Dentiste<\/option><option value=\"Directeur de laboratoire\">Directeur de laboratoire<\/option><option value=\"Fournisseur\">Fournisseur<\/option><option value=\"Infirmier\">Infirmier<\/option><option value=\"Masseur-kin\u00e9sith\u00e9rapeute\">Masseur-kin\u00e9sith\u00e9rapeute<\/option><option value=\"M\u00e9decin\">M\u00e9decin<\/option><option value=\"Orthophoniste\">Orthophoniste<\/option><option value=\"Orthoptiste\">Orthoptiste<\/option><option value=\"Pharmacien\">Pharmacien<\/option><option value=\"Podologue\">Podologue<\/option><option value=\"Sage-femme\">Sage-femme<\/option><option value=\"Transporteur\">Transporteur<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>N\u00b0 Identification Assurance Maladie (41...)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NumAM\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"NumAM\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Nom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Pr\u00e9nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Prenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Prenom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td>\n\t\t\t<p>&nbsp;\n\t\t\t<\/p>\n\t\t\t<h4>Mon changement d'adresse mail\n\t\t\t<\/h4>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p><strong>Je souhaite recevoir les diff\u00e9rentes informations via des adresses sp\u00e9cifiques :<\/strong>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t<\/tr>\n<\/table>\n<table>\n\t<td>\n\t\t<p>Adresse mail d\u00e9di\u00e9e au site Ameli.fr<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"MailAmeli\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"MailAmeli\" \/><\/span>\n\t\t<\/p>\n\t<\/td>\n\t<td style=\"padding-left:30px;\">\n\t<\/td>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Adresse mail d\u00e9di\u00e9e aux informations li\u00e9es aux rejets de flux de t\u00e9l\u00e9transmission<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"MailRejets\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"MailRejets\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Adresse mail d\u00e9di\u00e9e \u00e0 PGARDE - D\u00e9mat\u00e9rialisation des astreintes <i>(seulement pour m\u00e9decin et pharmacien)<\/i><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"MailPgarde\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"MailPgarde\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>J'autorise la CPAM de Loir-et-Cher \u00e0 utiliser les informations ci-dessus pour me contacter :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"UtilisationEmail\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"UtilisationEmail\" value=\"Oui\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"UtilisationEmail\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td>\n\t\t\t<p>&nbsp;\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p><i>Les informations recueillies font l\u2019objet d\u2019un enregistrement informatique destin\u00e9 \u00e0 vous envoyer des informations provenant de la Caisse d\u2019Assurance Maladie. Les destinataires des donn\u00e9es sont les services de la Caisse d\u2019Assurance Maladie. Conform\u00e9ment \u00e0 la loi informatique et libert\u00e9s du 06\/01\/1978, vous b\u00e9n\u00e9ficiez d\u2019un droit d\u2019acc\u00e8s et de rectification aux informations qui vous concernent. Si vous souhaitez exercer ce droit et obtenir communication des informations vous concernant, veuillez vous adresser au Correspondant Informatique et Libert\u00e9 de la Caisse d\u2019Assurance Maladie de Loir-et-Cher - 6 rue Louis Armand - 41022 Blois Cedex. Vous pouvez \u00e9galement pour des motifs l\u00e9gitimes, vous opposer au traitement des donn\u00e9es vous concernant.<\/i>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<table>\n\t\t<tr>\n\t\t\t<td>\n\t\t\t\t<p><b>Merci de saisir le code affich\u00e9 ci-dessous pour valider votre envoi : <\/b><br \/>\n<input type=\"hidden\" name=\"_wpcf7_captcha_challenge_captcha-170\" value=\"2170182138\" \/><img decoding=\"async\" class=\"wpcf7-form-control wpcf7-captchac wpcf7-captcha-captcha-170\" width=\"72\" height=\"24\" alt=\"captcha\" src=\"https:\/\/mes-formulaires.cpamcentre.fr\/wp-content\/uploads\/wpcf7_captcha\/2170182138.png\" \/><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"captcha-170\"><input size=\"4\" maxlength=\"4\" class=\"wpcf7-form-control wpcf7-captchar\" autocomplete=\"off\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"captcha-170\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t<\/table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p align=center><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_3\" name=\"_wpcf7_ak_js\" value=\"233\"\/><script>document.getElementById( \"ak_js_3\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<br \/>\n\t\t<\/div>\n\n\t\t<\/p>\n<p>\n\t\t\t\t\t<h2 role=\"button\" id=\"accordion-1-t4\" class=\"accordion-title js-accordion-controller\" aria-controls=\"accordion-1-c4\" aria-expanded=\"false\" tabindex=\"0\">\n\t\t\t\t&gt; Je change de statut juridique\t\t\t<\/h2>\n\t\t\n\t\t<div id=\"accordion-1-c4\" class=\"accordion-content\" aria-hidden=\"true\">\n\t\t\t<br \/>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f127-o4\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"127\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/149#wpcf7-f127-o4\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"127\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f127-o4\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<table border=0 padding=0 margin=0>\n\t<tr>\n\t\t<td>\n\t\t\t<h4>Mes informations\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Profession*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Profession\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Profession\"><option value=\"Dentiste\">Dentiste<\/option><option value=\"Directeur de laboratoire\">Directeur de laboratoire<\/option><option value=\"Fournisseur\">Fournisseur<\/option><option value=\"Infirmier\">Infirmier<\/option><option value=\"Masseur-kin\u00e9sith\u00e9rapeute\">Masseur-kin\u00e9sith\u00e9rapeute<\/option><option value=\"M\u00e9decin\">M\u00e9decin<\/option><option value=\"Orthophoniste\">Orthophoniste<\/option><option value=\"Orthoptiste\">Orthoptiste<\/option><option value=\"Pharmacien\">Pharmacien<\/option><option value=\"Podologue\">Podologue<\/option><option value=\"Sage-femme\">Sage-femme<\/option><option value=\"Transporteur\">Transporteur<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>N\u00b0 Identification Assurance Maladie (41...)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NumAM\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"NumAM\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Nom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Pr\u00e9nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Prenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Prenom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>T\u00e9l\u00e9phone*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Telephone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"Telephone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Adresse mail*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"Mail\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>J'accepte que mon adresse mail soit utilis\u00e9e par la CPAM<br \/>\nde Loir-et-Cher \u00e0 des fins d'information me concernant :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"UtilisationEmail\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"UtilisationEmail\" value=\"Oui\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"UtilisationEmail\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<h4>Mon changement de statut juridique\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Statut juridique actuel*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"StatutActuel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"StatutActuel\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Nouveau statut*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NouveauStatut\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"NouveauStatut\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Date d'effet (jj\/mm\/aaaa)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"DateEffet\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"DateEffet\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Cr\u00e9neau horaire o\u00f9 l'agent RPS peut me joindre<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"CreneauHoraire\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"CreneauHoraire\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p>&nbsp;\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p align=center><i>Pensez \u00e9galement \u00e0 en informer le Conseil de l'Ordre D\u00e9partemental.<\/i>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<table>\n\t\t<tr>\n\t\t\t<td>\n\t\t\t\t<p><b>Merci de saisir le code affich\u00e9 ci-dessous pour valider votre envoi : <\/b><br \/>\n<input type=\"hidden\" name=\"_wpcf7_captcha_challenge_captcha-170\" value=\"3289125720\" \/><img loading=\"lazy\" decoding=\"async\" class=\"wpcf7-form-control wpcf7-captchac wpcf7-captcha-captcha-170\" width=\"72\" height=\"24\" alt=\"captcha\" src=\"https:\/\/mes-formulaires.cpamcentre.fr\/wp-content\/uploads\/wpcf7_captcha\/3289125720.png\" \/><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"captcha-170\"><input size=\"4\" maxlength=\"4\" class=\"wpcf7-form-control wpcf7-captchar\" autocomplete=\"off\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"captcha-170\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t<\/table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p align=center><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_4\" name=\"_wpcf7_ak_js\" value=\"75\"\/><script>document.getElementById( \"ak_js_4\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<br \/>\n\t\t<\/div>\n\n\t\t<\/p>\n<p>\n\t\t\t\t\t<h2 role=\"button\" id=\"accordion-1-t5\" class=\"accordion-title js-accordion-controller\" aria-controls=\"accordion-1-c5\" aria-expanded=\"false\" tabindex=\"0\">\n\t\t\t\t&gt; Je change de relev\u00e9 d'identit\u00e9 bancaire (RIB)\t\t\t<\/h2>\n\t\t\n\t\t<div id=\"accordion-1-c5\" class=\"accordion-content\" aria-hidden=\"true\">\n\t\t\t<br \/>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f130-o5\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"130\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/149#wpcf7-f130-o5\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"130\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f130-o5\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<table border=0 padding=0 margin=0>\n\t<tr>\n\t\t<td>\n\t\t\t<h4>Mes informations\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Profession*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Profession\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Profession\"><option value=\"Dentiste\">Dentiste<\/option><option value=\"Directeur de laboratoire\">Directeur de laboratoire<\/option><option value=\"Fournisseur\">Fournisseur<\/option><option value=\"Infirmier\">Infirmier<\/option><option value=\"Masseur-kin\u00e9sith\u00e9rapeute\">Masseur-kin\u00e9sith\u00e9rapeute<\/option><option value=\"M\u00e9decin\">M\u00e9decin<\/option><option value=\"Orthophoniste\">Orthophoniste<\/option><option value=\"Orthoptiste\">Orthoptiste<\/option><option value=\"Pharmacien\">Pharmacien<\/option><option value=\"Podologue\">Podologue<\/option><option value=\"Sage-femme\">Sage-femme<\/option><option value=\"Transporteur\">Transporteur<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>N\u00b0 Identification Assurance Maladie (41...)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NumAM\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"NumAM\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Nom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Pr\u00e9nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Prenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Prenom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>T\u00e9l\u00e9phone*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Telephone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"Telephone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Adresse mail*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"Mail\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>J'accepte que mon adresse mail soit utilis\u00e9e par la CPAM<br \/>\nde Loir-et-Cher \u00e0 des fins d'information me concernant :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"UtilisationEmail\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"UtilisationEmail\" value=\"Oui\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"UtilisationEmail\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<h4>Mon changement de RIB\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Date d'effet (jj\/mm\/aaaa)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"DateEffet\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"DateEffet\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Joindre mon RIB (max. 1 Mo)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"RIB\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file wpcf7-validates-as-required\" accept=\".gif,.png,.jpg,.jpeg,.pdf,.tiff\" aria-required=\"true\" aria-invalid=\"false\" type=\"file\" name=\"RIB\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td>\n\t\t\t<p><b>Merci de saisir le code affich\u00e9 ci-dessous pour valider votre envoi : <\/b><br \/>\n<input type=\"hidden\" name=\"_wpcf7_captcha_challenge_captcha-170\" value=\"3855697325\" \/><img loading=\"lazy\" decoding=\"async\" class=\"wpcf7-form-control wpcf7-captchac wpcf7-captcha-captcha-170\" width=\"72\" height=\"24\" alt=\"captcha\" src=\"https:\/\/mes-formulaires.cpamcentre.fr\/wp-content\/uploads\/wpcf7_captcha\/3855697325.png\" \/><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"captcha-170\"><input size=\"4\" maxlength=\"4\" class=\"wpcf7-form-control wpcf7-captchar\" autocomplete=\"off\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"captcha-170\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p align=center><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_5\" name=\"_wpcf7_ak_js\" value=\"15\"\/><script>document.getElementById( \"ak_js_5\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<br \/>\n\t\t<\/div>\n\n\t\t<\/p>\n<p>\n\t\t\t\t\t<h2 role=\"button\" id=\"accordion-1-t6\" class=\"accordion-title js-accordion-controller\" aria-controls=\"accordion-1-c6\" aria-expanded=\"false\" tabindex=\"0\">\n\t\t\t\t&gt; Je change de nom\t\t\t<\/h2>\n\t\t\n\t\t<div id=\"accordion-1-c6\" class=\"accordion-content\" aria-hidden=\"true\">\n\t\t\t<br \/>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f132-o6\" lang=\"fr-FR\" dir=\"ltr\" data-wpcf7-id=\"132\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/149#wpcf7-f132-o6\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulaire de contact\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"132\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.0.6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"fr_FR\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f132-o6\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<table border=0 padding=0 margin=0>\n\t<tr>\n\t\t<td>\n\t\t\t<h4>Mes informations\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Profession*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Profession\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Profession\"><option value=\"Dentiste\">Dentiste<\/option><option value=\"Directeur de laboratoire\">Directeur de laboratoire<\/option><option value=\"Fournisseur\">Fournisseur<\/option><option value=\"Infirmier\">Infirmier<\/option><option value=\"Masseur-kin\u00e9sith\u00e9rapeute\">Masseur-kin\u00e9sith\u00e9rapeute<\/option><option value=\"M\u00e9decin\">M\u00e9decin<\/option><option value=\"Orthophoniste\">Orthophoniste<\/option><option value=\"Orthoptiste\">Orthoptiste<\/option><option value=\"Pharmacien\">Pharmacien<\/option><option value=\"Podologue\">Podologue<\/option><option value=\"Sage-femme\">Sage-femme<\/option><option value=\"Transporteur\">Transporteur<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>N\u00b0 Identification Assurance Maladie (41...)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NumAM\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"NumAM\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Nom actuel*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Nom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Nom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Pr\u00e9nom*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Prenom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Prenom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>T\u00e9l\u00e9phone*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Telephone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"Telephone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Adresse mail*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"Mail\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>J'accepte que mon adresse mail soit utilis\u00e9e par la CPAM<br \/>\nde Loir-et-Cher \u00e0 des fins d'information me concernant :<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"UtilisationEmail\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"UtilisationEmail\" value=\"Oui\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Oui<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"UtilisationEmail\" value=\"Non\" \/><span class=\"wpcf7-list-item-label\">Non<\/span><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<h4>Mon changement de Nom\n\t\t\t<\/h4>\n\t\t<\/td>\n\t\t<td>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Nouveau nom d'exercice*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"NouveauNom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"NouveauNom\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t\t<p>Date d'effet (jj\/mm\/aaaa)*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"DateEffet\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"DateEffet\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td>\n\t\t\t<p>Joindre mon justificatif (acte de mariage, livret de famille)* - max. 1 Mo<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Justificatif\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file wpcf7-validates-as-required\" accept=\".gif,.png,.jpg,.jpeg,.pdf,.tiff\" aria-required=\"true\" aria-invalid=\"false\" type=\"file\" name=\"Justificatif\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/td>\n\t\t<td style=\"padding-left:30px;\">\n\t\t<\/td>\n\t<\/tr>\n<\/table>\n<table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p>&nbsp;\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p align=center><i>Pensez \u00e9galement \u00e0 en informer le Conseil de l'Ordre D\u00e9partemental.<\/i>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n\t<table>\n\t\t<tr>\n\t\t\t<td>\n\t\t\t\t<p><b>Merci de saisir le code affich\u00e9 ci-dessous pour valider votre envoi : <\/b><br \/>\n<input type=\"hidden\" name=\"_wpcf7_captcha_challenge_captcha-170\" value=\"1281330056\" \/><img loading=\"lazy\" decoding=\"async\" class=\"wpcf7-form-control wpcf7-captchac wpcf7-captcha-captcha-170\" width=\"72\" height=\"24\" alt=\"captcha\" src=\"https:\/\/mes-formulaires.cpamcentre.fr\/wp-content\/uploads\/wpcf7_captcha\/1281330056.png\" \/><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"captcha-170\"><input size=\"4\" maxlength=\"4\" class=\"wpcf7-form-control wpcf7-captchar\" autocomplete=\"off\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"captcha-170\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t<\/table>\n\t<tr>\n\t\t<td style=\"padding:0;margin:0;\">\n\t\t\t<p align=center><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Envoyer\" \/>\n\t\t\t<\/p>\n\t\t<\/td>\n\t<\/tr>\n<\/table><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_6\" name=\"_wpcf7_ak_js\" value=\"75\"\/><script>document.getElementById( \"ak_js_6\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<br \/>\n\t\t<\/div>\n\n\t\t<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Afin de faciliter nos \u00e9changes, nous vous proposons de compl\u00e9ter les formulaires ci-dessous en indiquant les informations relatives \u00e0 votre changement de situation. Pensez \u00e9galement \u00e0 faire les d\u00e9marches n\u00e9cessaires aupr\u00e8s des autres organismes (URSSAF, Conseil de l&rsquo;Ordre&#8230;). Cliquez sur la situation concern\u00e9e :<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-149","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/149"}],"collection":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/comments?post=149"}],"version-history":[{"count":4,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/149\/revisions"}],"predecessor-version":[{"id":304,"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/pages\/149\/revisions\/304"}],"wp:attachment":[{"href":"https:\/\/mes-formulaires.cpamcentre.fr\/index.php\/wp-json\/wp\/v2\/media?parent=149"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}