Use this form for a patient 6 to 17 years of age, who is continuing PBS subsidised treatment of adalimumab or infliximab for the treatment of Crohn disease.
This form is to be completed by a:
- gastroenterologist (code 87)
- consultant physician in internal medicine specialising in gastroenterology (code 81)
- consultant physician in general medicine specialising in gastroenterology (code 82)
- paediatrician, or
- specialist paediatric gastroenterologist
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.