Relapsed or refractory Hodgkin lymphoma (autologous stem cell transplant (ASCT) failure) Initial PBS authority application form (PB204)

Use this form to apply for initial PBS subsidised brentuximab vedotin treatment for a patient with post-ASCT relapsed or refractory Hodgkin lymphoma.

This form can be uploaded through HPOS. Read more about form upload in HPOS.
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Page last updated: 1 April 2017

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