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.

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: 13 November 2018

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