Aboriginal Health Services (AHS) pharmaceutical supplies request form (PB042)

Use this form to request and claim payment for the provision of eligible pharmaceutical benefits to an approved AHS.

You can only claim for payment of the section 100 (s100) Remote Area Aboriginal Health Services (RAAHS) patient specific medicine supply fee (PSMSF) for eligible pharmaceutical benefits provided on or after 1 January 2018. 

If you’re claiming the s100 RAAHS PSMSF for eligible pharmaceutical benefits provided before this date you need to send your claim to the Pharmacy Guild of Australia.

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: 22 October 2018

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