Secukinumab for ankylosing spondylitis Initial PBS grandfather authority application form (PB183)

Use this form for an adult patient starting initial (grandfather) PBS subsidised treatment with secukinumab only.

This form must be completed by a rheumatologist.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

Page last updated: 14 October 2016

This information was printed Monday 5 December 2016 from humanservices.gov.au/health-professionals/forms/pb183 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.