Severe chronic plaque psoriasis for patients under 18 years - initial PBS authority application form (PB116)

Use this form for the treatment of a patient younger than 18 with etanercept for severe chronic plaque psoriasis who is starting initial or recommencing PBS subsidised treatment.

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.
This information was printed Sunday 26 May 2019 from https://www.humanservices.gov.au/organisations/health-professionals/forms/pb116 It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.humanservices.gov.au/individuals/site-notices when using this material.

Page last updated: 10 April 2019