Use this form to apply for initial PBS subsidised treatment with brentuximab vedotin for post-ASCT relapsed or refractory Hodgkin lymphoma.
- Relapsed or refractory Hodgkin lymphoma - brentuximab (autologous stem cell transplant (ASCT) failure) initial PBS authority application form
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.