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), a consultant physician in internal medicine specialising in gastroenterology (code 81) or a consultant physician in general medicine specialising in gastroenterology (code 82).

PBS is the Pharmaceutical Benefits Scheme.

TNF is the Tumour Necrosis Factor.

 
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Page last updated: 21 September 2017