Azacitidine initial PBS authority application form (PB079)
Use this form for a patient starting initial PBS subsidised treatment with azacitidine for the treatment of myelodysplastic syndrome, chronic myelomonocytic leukaemia, or acute myeloid leukaemia.
PBS is the Pharmaceutical Benefits Scheme.
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.
Page last updated: 10 April 2019