Rheumatoid arthritis Initial PBS grandfather authority application form (PB110)

Use this form for an adult patient starting initial PBS subsidised treatment with tofacitinib only for the treatment of rheumatoid arthritis.

This form must be completed by a rheumatologist or clinical immunologist with expertise in the management of rheumatoid arthritis.

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