Retinal Vein Occlusion Initial PBS authority application Supporting information form (PB154)

Use this form for a patient starting initial PBS subsidised treatment with ranibizumab or aflibercept for the treatment of visual impairment due to macular oedema secondary to BRVO or CRVO.

PBS is the Pharmaceutical Benefits Scheme.

BRVO is the Branched Retinal Vein Occlusion.

CRVO is the Central Retinal Vein Occlusion.
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