Pharmaceutical Benefits Scheme receipt - S.87A, National Health Act 1953 form (PB011)
Use this form as the official Medicare patient refund receipt that authorised pharmacists can issue for pharmaceutical benefit items supplied.
Download and complete the Pharmaceutical Benefits Scheme receipt - S.87A, National Health Act 1953 form.
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: 31 January 2020