Chronic myeloid leukaemia, chronic phase, first line - initial PBS authority application form (PB083)

Use this form for a patient starting first line initial PBS subsidised treatment with a tyrosine kinase inhibitor (TKI) agent for chronic phase of chronic myeloid leukaemia expressing the Philadelphia chromosome or the transcript BCR-ABL tyrosine kinase.

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: 13 February 2019