PBS Safety Net claim for payment form (PB241)

Use this form if you are an approved supplier claiming a payment for issuing a PBS Safety Net card.

PBS is the Pharmaceutical Benefits Scheme.

We require you to keep a copy of the completed form that is submitted to the department for your records.

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. Handwritten, incomplete or poor quality forms will be returned.

Page last updated: 4 December 2018