Severe chronic plaque psoriasis Continuing PBS authority application form (PB113)

Use this form for an adult patient who is continuing PBS subsidised treatment, changing to an alternate PBS subsidised treatment or demonstrating a response to the current PBS subsidised treatement.

A dermatologist must complete this form.

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