Ulcerative colitis (moderate to severe) initial grandfather PBS authority application form (PB191)

Use this form for a patient starting Grandfathered PBS subsidised treatment with adalimumab for ulcerative colitis.

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: 5 December 2016

This information was printed Wednesday 26 April 2017 from humanservices.gov.au/health-professionals/forms/pb191 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.