Seemingly valid Medicare card form (PB136)

Use this form if you are a pharmacist who have previously submitted a PBS or RPBS claim to us which has been rejected based on the patients Medicare card number.

Complete this form for your patient if we found that the Medicare or Repatriation card details were invalid, and they have presented another script and cannot provide an alternative Medicare or Repatriation card details.

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

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 22 October 2018

Was this page useful?
Why?
Why not?

Thank you for your feedback.