Alzheimer disease - initial PBS authority application form (PB121)

Use this form to apply for initial PBS subsidised treatment for patients with Alzheimer's disease.

Download and complete the Alzheimer disease - 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 April 2020