Request for prescriber bag supplies order book form (PB157)

Use this form to order the Prescriber bag supplies order book to get some PBS medicines to give to patients for emergency use if you are an eligible prescriber.

We will only accept typed prescription order forms. We will return handwritten, incomplete or poor quality forms to the prescriber.

PBS is the Pharmaceutical Benefits Scheme. 

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: 20 September 2019