Ulcerative colitis moderate to severe - Adult patients Initial PBS authority application form (PB127)

Use this form to apply for initial PBS subsidised treatment with adalimumab, golimumab, infliximab and vedolizumab for moderate to severe ulcerative colitis.

You can also use this form to apply for changing or recommencing treatment for an adult patient with moderate to severe ulcerative colitis.

 
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: 1 June 2018