Diabetic Macular Oedema Initial PBS authority application form (PB155)

Use this form to apply for initial PBS subsidised treatment with ranibizumab, aflibercept or dexamethasone intravitreal implants for a patient with 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: 1 October 2017