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