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.
If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.
Page last updated: 14 November 2018