PIP Indigenous Health Incentive patient withdrawal of consent form (IP029)

Use this form to withdraw your consent to participate in the PIP Indigenous Health Incentive or the Pharmaceutical Benefits Scheme (PBS) Co-payment Measure.

This form needs to be completed and signed by the patient withdrawing their consent from the Practice Incentives Program (PIP) Indigenous Health Incentive or the Pharmaceutical Benefits Scheme Co-payment Measure.

 

Page last updated: 24 August 2016

This information was printed Sunday 2 October 2016 from humanservices.gov.au/health-professionals/forms/ip029 It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.