Gastrointestinal stromal tumour, adjuvant - initial PBS authority application form (PB057)

Use this form for a patient starting initial PBS subsidised treatment with imatinib mesylate following complete resection of primary gastrointestinal stromal tumour and who is at high risk of recurrence.

This form must be completed by the prescriber.

PBS is the Pharmaceutical Benefits Scheme.

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: 13 February 2019

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