Authority for authorised pharmacists to sign claim forms on behalf of approved pharmacists form (PB135)

Use this form to authorise a pharmacist to sign pharmaceutical benefit claim forms and endorse pharmaceutical benefit prescriptions on behalf of the approved pharmacist.

An approved pharmacist and business owner of a pharmacy approved under section 90 of the National Health Act 1953 can use this form.

You can also use this form to request removal of previously authorised pharmacists.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

Page last updated: 13 November 2018