Request for Pharmaceutical Benefits Scheme claims information form (MS040)

Use this form to request Pharmaceutical Benefits Scheme (PBS) claims information for individuals and families from more than 2 years ago.

This form should only be used to request PBS claims information from more than 2 years ago.

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

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 8 January 2020