Systemic juvenile idiopathic arthritis - continuing PBS authority application form (PB118)

Use this form for a patient who is continuing PBS subsidised tocilizumab treatment for 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.
This information was printed Tuesday 21 May 2019 from https://www.humanservices.gov.au/organisations/health-professionals/forms/pb118 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