Crohn disease Initial paediatric PBS authority application form (PB085)

Use this form for a patient aged 6 to 17 years of age starting initial PBS subsidised treatment with infliximab for Crohn disease.

A gastroenterologist or paediatrician must complete this form.

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