In exceptional circumstances, a second derogation, for a maximum period of three years, may be granted by the Prefect, on the basis of a report by the Director General of the Regional Health Agency, for the cases provided for in 1° and 2° of I of article R. 1321-31. The request, accompanied by the file, must be sent to the Prefect no later than six months before the end of the derogation period and must include an interim report justifying this second request. The Prefect’s decision includes the information specified in 2° of article R. 1321-32.
If the Prefect remains silent for more than six months, this is deemed to be a decision of acceptance.