Azacitidine initial PBS authority application form (PB079)
Use this form for a patient starting initial PBS subsidised treatment with azacitidine for the treatment of myelodysplastic syndrome, chronic myelomonocytic leukaemia, or acute myeloid leukaemia.
Download and complete the Azacitidine initial PBS authority application form.
PBS is the Pharmaceutical Benefits Scheme.
This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.
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Page last updated: 31 January 2020