Systemic Juvenile idiopathic arthritis Initial PBS authority application form (PB117)

Use this form for a patient under 18 years of age for PBS subsidised treatment with tocilizumab for the treatment of severe active systemic juvenile idiopathic arthritis.

A paediatric rheumatologist or a prescriber under the supervision of a paediatric rheumatology treatment centre 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