Acute Lymphoblastic Leukaemia – dasatinib Initial PBS authority application form (PB077)

You must lodge this form for a patient starting initial Pharmaceutical Benefits Scheme (PBS) subsidised treatment with dasatinib for acute lymphoblastic leukaemia.

 

Page last updated: 15 June 2016

This information was printed Wednesday 28 September 2016 from humanservices.gov.au/health-professionals/forms/pb077 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.