Familial homozygous hypercholesterolaemia initial PBS authority application form (PB186)

Use this form for a patient starting initial PBS subsidised treatment with evolocumab for the treatment of familial homozygous hypercholesterolaemia.

This form can be uploaded through HPOS. Read more about form upload in HPOS.
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

Page last updated: 22 February 2017

This information was printed Friday 24 March 2017 from humanservices.gov.au/health-professionals/forms/pb186 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.