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.
This information was printed Tuesday 21 May 2019 from https://www.humanservices.gov.au/organisations/health-professionals/forms/pb082 It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.

Page last updated: 13 February 2019