Myelodysplastic syndrome Initial PBS authority application and supporting information form (PB012)

Lodge this form for a patient starting initial PBS subsidised treatment with lenalidomide or applying for the first continuing PBS subsidised treatment. The patient and prescriber acknowledgements must be completed.

 

Page last updated: 5 February 2016

This information was printed Thursday 29 September 2016 from humanservices.gov.au/health-professionals/forms/pb012 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.