Severe asthma – adolescent and adult initial and recommencement after 12 months break authority application form (PB075)
Use this form to apply for initial PBS subsidised treatment with a biological agent for an adult or adolescent patient with uncontrolled severe asthma.
Biological agent refers to:
- benralizumab
- dupilumab
- mepolizumab
- omalizumab.
Download and complete the severe asthma – adolescent and adult initial and recommencement after 12 months break authority application form.
This PDF is fillable. You can fill it out on your device, or print it and complete it by hand.
You can upload this form in HPOS.
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: 1 July 2021
This information was printed 27 November 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/pb075. 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.