Aboriginal Health Services (AHS) pharmaceutical supplies request form (PB042)
Use this form to request and claim payment for the provision of eligible pharmaceutical benefits to an approved AHS.
Download and complete the Aboriginal Health Services (AHS) pharmaceutical supplies request and claim form.
You can only claim for payment of the section 100 (s100) Remote Area Aboriginal Health Services (RAAHS) patient specific medicine supply fee (PSMSF) for eligible pharmaceutical benefits provided on or after 1 January 2018.
If you’re claiming the s100 RAAHS PSMSF for eligible pharmaceutical benefits provided before this date you need to send your claim to the Pharmacy Guild of Australia.
This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.
If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.
Page last updated: 20 February 2020
This information was printed 21 January 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/pb042. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.