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 form can be uploaded through HPOS. Read more about form upload in HPOS.
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

Page last updated: 13 February 2019