Ulcerative colitis (moderate to severe) - Paediatric patients Initial PBS authority application form (PB215)

Use this form to apply for initial PBS subsidised adalimumab or infliximab treatment for a patient 6 to 17 years of age with moderate to severe ulcerative colitis.

You can also use this form to apply for changing or recommencing treatment for a patient 6 to 17 year of age with moderate to severe ulcerative colitis.

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