PIP Indigenous Health Incentive - patient withdrawal of consent form (IP029)

Use this form to withdraw your consent to participate in the PIP Indigenous Health Incentive or the Pharmaceutical Benefits Scheme (PBS) Co-payment Measure.

This form needs to be completed and signed by the patient withdrawing their consent from the Practice Incentives Program (PIP) Indigenous Health Incentive or the Pharmaceutical Benefits Scheme Co-payment Measure.

 
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
This information was printed Sunday 26 May 2019 from https://www.humanservices.gov.au/organisations/health-professionals/forms/ip029 It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.

Page last updated: 14 November 2018