Severe chronic plaque psoriasis for patients under 18 years - initial PBS authority application form (PB116)
Use this form for the treatment of a patient younger than 18 with etanercept for severe chronic plaque psoriasis who is starting initial or recommencing PBS subsidised treatment.
Download and complete the Severe chronic plaque psoriasis for patients under 18 years - initial PBS authority application form.
A dermatologist must complete this 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