Early breast cancer Initial PBS authority application form (PB094)

Use this form for a patient starting initial PBS subsidised treatment with trastuzumab for the treatment of HER2 positive early or locally advanced breast cancer.

PBS is the Pharmaceutical Benefits Scheme.

HER2 is the Human Epidermal Growth Factor Receptor 2.

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