Crohn's disease - paediatric change or recommencement PBS authority application form (PB239)
Use this form to apply for changing or recommencing PBS subsidised biological agent treatment for paediatric patients with Crohn’s disease.
Download and complete the Crohn's disease - paediatric change or recommencement PBS authority application form.
This form is for paediatric patients aged 6 to 17.
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.
If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.
Page last updated: 20 February 2020
This information was printed 16 January 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/pb239. 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.