Myelofibrosis - initial PBS authority application form (PB172)
Use this form for a patient starting initial PBS subsidised treatment for high risk, intermediate-2 risk or intermediate-1 risk myelofibrosis.
Download and complete the Myelofibrosis - initial PBS authority application 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: 20 February 2020
This information was printed 19 January 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/pb172. 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.