Diabetic Macular Oedema Initial PBS authority application form (PB155)

Use this form for a patient starting initial PBS subsidised treatment for visual impairment due to DMO.

PBS is the Pharmaceutical Benefits Scheme.

DMO is the Diabetic Macular Oedema.

 
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