Juvenile idiopathic arthritis for adult patients with onset prior to age 18 Continuing PBS authority application form (PB063)

Use this form for an adult patient with a documented history of juvenille idiopathic arthritis with the onset prior to age 18 continuing PBS subsidised treatment with bDMARD.

You should also use this form if the patient is changing to an alternate PBS subsidised treatment, recommencing treatment with the most recent PBS subsidised bDMARD or demonstrating a response to the current PBS subsidised treatment.

A rheumatologist or clinical immunologist with expertise in the management of rheumatoid arthritis must complete this form.

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: 27 August 2017