Ankylosing spondylitis Continuing PBS authority application form (PB074)

Use this form for an adult patient who is, continuing PBS subsidised treatment, changing to an alternate PBS subsidised treatment for which the patient is eligible, demonstrating a response to the current PBS subsidised treatment.

This form must be completed by a rheumatologist with expertise in the management of ankylosing spondylitis.

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