Myelodysplastic syndrome - lenalidomide - initial or first continuing authority application form (PB012)

Use this form to apply for initial or first continuing PBS-subsidised treatment with lenalidomide for myelodysplastic syndrome.

You don’t need to complete this form if you use the Online PBS Authorities system.

Download and complete the Myelodysplastic syndrome - lenalidomide - initial or first continuing authority application form.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

You can upload this form in HPOS.

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Page last updated: 1 July 2022