Acute lymphoblastic leukaemia - inotuzumab ozogamicin initial (induction) authority application form (PB269)
Use this form to apply for initial (induction) PBS subsidised inotuzumab ozogamicin treatment for acute lymphoblastic leukaemia.
Download and complete the Acute lymphoblastic leukaemia - inotuzumab ozogamicin initial (induction) authority application form.
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Page last updated: 18 May 2021
This information was printed 7 October 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/pb269. 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.