ALD care protocol in psychiatry: template, outline and example

The ALD care protocol (protocole de soins) is the document a patient's GP uses to ask French national health insurance to cover 100% of the care linked to a long-term condition. In psychiatry this is usually ALD 23, "long-term psychiatric conditions". The psychiatrist does not always fill it in, but supplies most of the clinical arguments.

This page explains who completes the protocol and the ALD 23 criteria as set out by the HAS (the French national health authority). It then covers the process described by Ameli (the health insurance website) and gives an outline and a filled-in example with a fictional patient. Information was checked on ameli.fr and has-sante.fr on 9 October 2026.

Who fills in the care protocol

In principle, the GP (médecin traitant). According to Ameli, the GP draws up the protocol together with the patient and the other doctors involved in the condition. The HAS ALD 23 guides say the same, whether the médecin traitant works in the community or in a hospital.

The psychiatrist can contribute. Ameli states that a corresponding doctor, specialist or not, can take part with the GP in drawing up the protocol. In practice, your role is often to send the GP a letter setting out the diagnosis, duration, functional impact and care plan. If you are the patient's declared médecin traitant yourself, the protocol is yours to complete.

Hospital diagnosis. Ameli notes that, to avoid delaying cover, the health insurance fund can open rights straight away when the diagnosis is made in hospital, even without a request from the GP.

ALD 23 and its three criteria

ALD 23 is on the list of long-term conditions set by decree. The HAS guides state that three types of medical criteria must all be met for the patient to be exempt from co-payment.

• Diagnosis, made according to the ICD-10 list and criteria.
• Duration, more than one year at the time of the application. According to the HAS, the GP must give chronological markers of the illness.
• Functional impact, which must be major and directly related to the condition. The HAS asks for a description of the disability in daily life, because in psychiatry the severity of the diagnosis does not always match the severity of the disability.

A diagnosis alone is not enough. A protocol that does not describe duration and impact is unlikely to succeed.

Examples from the HAS documents. Chapter a) covers psychoses (schizophrenia, schizoaffective disorders, persistent delusional disorders). Acute and transient psychotic disorders, such as an isolated brief psychotic episode, are not covered. Chapter d) covers severe neurotic disorders and severe personality and behavioural disorders, among others. The HAS publishes ALD 23 guides for schizophrenia, severe anxiety disorders, bipolar disorders and recurrent or persistent depressive disorders in adults.

Duration of cover. It depends on the chapter. The HAS guide on schizophrenia (July 2025 update) gives an initial exemption of ten years, renewable, for the psychoses in chapter a), following a July 2024 decree. The HAS guide on severe anxiety disorders gives five years, renewable. Ameli adds that ALD status can be renewed with no age limit and no limit on renewals while active care is still needed.

The process, step by step

1. Online application on amelipro

• Log in to amelipro with strong authentication (CPS, CPE or e-CPS card).
• Identify the patient with their Carte Vitale, the Carte Vitale app or their social security number (NIR).
• Open the "Affections de longue durée" service in the patient services section.
• For patients covered by another scheme, the request is printed and posted. A paper form can also be ordered on amelipro.

2. Review by the medical service

• The health insurance medical service gives its opinion within 30 days of the request, according to Ameli.
• It may contact the doctor, including through amelipro.

3. The decision

• If approved, the doctor finalises the request in amelipro, prints the statement of cover and gives it to the patient during a consultation. The patient also receives a letter.
• If refused, the fund informs the patient, who can apply to the medical amicable appeals board (CMRA) within 30 days.
• The patient's section is offered for upload to the shared medical record (DMP), viewable in Mon espace santé.

4. Simplified declaration

Some ALDs qualify for a simplified declaration, limited to the diagnosis and start date. Ameli states that this does not apply to some ALD 23 conditions (the page lists, among others, recurrent or persistent mood disorders, severe neurotic disorders, severe personality and behavioural disorders and addictive disorders). Clinical details must then be given.

The outline, section by section

This outline follows the protocol content described by Ameli and the HAS criteria. It works for the GP completing the protocol and for the psychiatrist writing a supporting letter.

1. Diagnosis and clinical arguments

• ICD-10 diagnosis, with the code if you use it.
• The main clinical findings behind it, as observed facts.
• Psychiatric and addictive comorbidities that affect care.

2. Duration and timeline

• Date or period of first symptoms.
• Date of diagnosis and by whom.
• Admissions and relapses, with dates.

3. Functional impact

• Daily living (independence, hygiene, eating, paperwork).
• Work or education (sick leave, job loss, adjustments).
• Social and family life (isolation, broken ties).
• Cognitive, emotional and behavioural aspects, as the HAS requires.

4. Care and treatment needed

• Psychiatric follow-up and its frequency.
• Medication, within its marketing authorisation.
• Blood tests and monitoring linked to treatment.
• Other professionals involved, using the HAS list of services for the condition.
• Which care is covered at 100%, which stays at the usual rate and which is not covered.

5. Direct-access specialists and transport

• Any direct access to specialists, such as the psychiatrist.
• Transport linked to the illness, if needed.

6. The psychiatrist's letter to the GP

• A clear subject line (information for an ALD 23 application).
• The three criteria, each in a short paragraph.
• The care plan and what you will provide yourself.
• Your availability to discuss it.

For tone and format, see our psychiatrist's letter to the GP template.

Filled-in example

Subject. Letter from Dr A., psychiatrist, to Dr B., GP, about Mr Julien R., 29. Information for an ALD 23 application.

Diagnosis. Schizophrenia according to ICD-10. The diagnosis rests on persecutory delusions, auditory hallucinations and social withdrawal that developed gradually and were confirmed during two admissions.

Duration. First symptoms reported by the family in 2022. Diagnosis made during an admission in 2023. Further four-week admission in 2025 after stopping treatment. Regular outpatient follow-up since 2023.

Functional impact. Dropped out of his vocational course in 2023, not resumed. Lives with his parents, who handle his paperwork. Rarely goes out, no regular friendships. Concentration problems prevent him from attending training. Hygiene and eating adequate with prompting from family.

Care needed. Monthly psychiatric consultation. Long-term antipsychotic treatment with blood and metabolic monitoring. Nursing follow-up at the community mental health centre. Referral to a psychosocial rehabilitation programme in progress.

Conclusion of the letter. In my view the three ALD 23 criteria are met (ICD-10 diagnosis, duration over one year, major functional impact directly linked to the illness). I am happy to complete the protocol with you.

Common mistakes

• Giving only the diagnosis. Without a dated history and a description of impact, the medical service lacks evidence.
• Describing impact in vague terms. "Impaired functioning" says nothing. Write what the patient can no longer do.
• Confusing clinical severity with disability. The HAS points out that the two do not always go together. Disability is what matters here.
• Including off-label treatments in 100% cover. According to Ameli, they are not covered.
• Not explaining the protocol to the patient. They need to know which care is fully covered and which is not.
• Using the simplified declaration when it does not apply. Several ALD 23 conditions require clinical detail.

Save time with Delta

Delta is a clinical assistant for mental health and allied health professionals. During the consultation, Delta transcribes what is said, or you dictate your observations afterwards. Delta generates the session report and updates the patient record with a summary of care and the goals being tracked.

Delta also drafts letters, certificates and assessment reports adapted to your profession. The supporting letter to the GP for an ALD application is a good example. You start from an up-to-date summary of care, then review, complete and sign. The GP still enters the protocol on amelipro.

Data is hosted in France by an HDS-certified provider, with AI processing in France. The patient's name and identifying details are pseudonymised before the AI step, no audio file is kept and data is never used to train a model. Read what is Delta or the Delta for psychiatrists page. The trial lasts 14 days with no credit card.

Frequently asked questions

Further reading

• Psychiatrist's letter to the GP.
• Psychiatric consultation report template.
• Mental status examination template.
• Medical certificates in psychiatry.
• All our clinical document templates.
• Choosing an AI scribe as a psychiatrist.
• AI note-taking software compared.

Sources

• Ameli, care protocol for a patient with an exempting ALD (in French).
• HAS, ALD 23 Schizophrenia, services list (July 2025 update, in French).
• HAS, ALD 23 Severe anxiety disorders, services list (in French).
• HAS, ALD 23 Recurrent or persistent depressive disorders in adults (in French).