Chronic myeloid leukaemia, accelerated or blast phase, First Line - imatinib mesilate Initial PBS authority application form (PB082)

Use this form to apply for initial PBS subsidised imatinib mesilate treatment for a patient with accelerated or blast phase of chronic 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