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.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

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Page last updated: 13 February 2019

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