Metastatic stage IV HER2 positive adenocarcinoma of the stomach or gastro-oesophageal junction Initial PBS Authority application form (PB173)

Use this form for a patient starting initial PBS subsidised treatment with trastuzumab for metastatic stage IV Human Epidermal Growth Factor Receptor 2 (HER2) positive adenocarcinoma of the stomach or gastro-oesophageal junction.

 
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