Idiopathic thrombocytopenic purpura - initial PBS authority application form (PB097)
Use this form for an adult patient starting initial PBS subsidised treatment with either eltrombopag or romiplostim for the treatment of severe chronic immune idiopathic thrombocytopenic purpura.
Download and complete the Idiopathic thrombocytopenic purpura - initial PBS authority application form.
PBS is the Pharmaceutical Benefits Scheme.
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.
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Page last updated: 20 February 2020
This information was printed 6 January 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/pb097. 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.