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

Use this form to apply for initial grandfather PBS subsidised adalimumab treatment for a patient with moderate to severe ulcerative colitis.

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Page last updated: 16 August 2017

This information was printed Thursday 17 August 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.