Acute lymphoblastic leukaemia - blinatumomab Initial (Induction) PBS authority application form (PB210)

Use this form to apply for initial (induction) PBS subsidised blinatumomab treatment for a patient with acute lymphoblastic leukaemia.

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Page last updated: 1 May 2017

This information was printed Monday 24 July 2017 from humanservices.gov.au/health-professionals/forms/pb210 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.