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.