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 PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

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Page last updated: 13 February 2019

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