Myelodysplastic syndrome Initial PBS authority application form (PB012)

Use this form for a patient starting initial PBS subsidised treatment with lenalidomide or applying for the first continuing PBS subsidised treatment.

The patient and prescriber acknowledgements must be completed.

PBS is the Pharmaceutical Benefits Scheme.

This form can be uploaded through HPOS. Read more about form upload in HPOS.

Page last updated: 27 August 2017