Fistulising Crohn disease Initial PBS authority application form (PB092)

Use this form for a patient starting initial PBS subsidised treatment with a TNF alpha antagonist for the treatment of complex refractory fistulating Crohn's Disease.

This form must be completed by a:

  • gastroenterologist (code 87)
  • consultant physician in internal medicine specialising in gastroenterology (code 81), or
  • consultant physician in general medicine specialising in gastroenterology (code 82)

PBS is the Pharmaceutical Benefits Scheme.

TNF is the Tumour Necrosis Factor.

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: 12 April 2018