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 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: 1 May 2019

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