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

Use this form to apply for continuing, changing or recommencing PBS subsidised treatment with a biological agent for an adult patient with severe chronic plaque psoriasis.

A dermatologist must complete this form.

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: 23 January 2018