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 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