Chronic myeloid leukaemia Continuing PBS authority application form (PB084)

Use this form for a patient continuing PBS subsidised treatment with a tyrosine kinase inhibitor (TKI) agent for any 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: 27 August 2017