Severe chronic plaque psoriasis for patients under 18 years - etanercept - initial authority application form (PB116)

Use this form to apply for initial or recommencing PBS subsidised treatment of paediatric patients with etanercept for severe chronic plaque psoriasis.

Download and complete the severe chronic plaque psoriasis for patients under 18 years - etanercept - initial authority application form.

A dermatologist must complete this 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.

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Page last updated: 4 January 2021