Crohn disease Continuing paediatric PBS authority application form (PB161)

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 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: 12 April 2018