Adolescent and adult severe allergic asthma - continuing PBS authority application form (PB076)
Use this form to apply for continuing Pharmaceutical Benefits Scheme (PBS) subsidised treatment with omalizumab for uncontrolled severe allergic asthma.
This form is for patients aged 12 years or older.
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
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Page last updated: 1 December 2018