PBS/RPBS Safety Net prescription record form and application for a Safety Net card form (PB240)

Use this form to help you keep a record of how much you have spent on PBS/RPBS medicines and to apply for a PBS Safety Net card.

PBS is the Pharmaceutical Benefits Scheme.

RPBS is the Repatriation Pharmaceutical Benefits Scheme.

Page 1 of this form must be typed.

Each time you have a PBS/RPBS medicine supplied, hand both pages 1 and 2 of this form to the pharmacist.

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: 4 December 2018