Acute lymphoblastic leukaemia – second line - dasatinib initial PBS authority application form (PB077)
Use this form to apply for initial PBS subsidised dasatinib for second line treatment of acute lymphoblastic leukaemia.
Download and complete the acute lymphoblastic leukaemia – second line - dasatinib initial PBS authority application form.
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Page last updated: 6 November 2020
This information was printed 15 October 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/pb077. 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.