Subfoveal choroidal neovascularisation Initial PBS authority application form (PB072)

Use this form for a patient starting initial PBS subsidised treatment with aflibercept, ranibizumab or verteporfin for the treatment of subfoveal choroidal neovascularisation due to age-related macular degeneration.

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