Chronic myeloid leukaemia continuing PBS authority application form (PB084)

Use this form to apply for continuing PBS subsidised treatment with tyrosine kinase inhibitor (TKI) agents for chronic myeloid leukaemia.

TKI agents refers to all of the following:

  • dasatinib
  • imatinib
  • nolitinib
  • ponatinib.
 
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 Sunday 26 May 2019 from https://www.humanservices.gov.au/organisations/health-professionals/forms/pb084 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: 1 May 2019