Cystic Fibrosis - Ivacaftor Initial grandfather PBS authority application form (PB212)

Use this form to apply for initial grandfather PBS subsidised ivacaftor treatment for a patient aged 2 to 5 years with cystic fibrosis.

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: 1 May 2017

This information was printed Friday 23 June 2017 from humanservices.gov.au/health-professionals/forms/pb212 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.