Acute Lymphoblastic Leukaemia – imatinib mesylate Initial PBS authority application form (PB078)

Complete this form for a patient who is starting initial Pharmaceutical Benefits Scheme (PBS) subsidised treatment with imatinib mesylate for acute lymphoblastic leukaemia.

 

Page last updated: 15 June 2016

This information was printed Friday 30 September 2016 from humanservices.gov.au/health-professionals/forms/pb078 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.