Idiopathic thrombocytopenic purpura - eltrombopag or romiplostim - first continuing or re-initiation of interrupted continuing authority application form (PB098)

Use this form to apply for first continuing or re-initiation of interrupted continuing PBS-subsidised treatment with eltrombopag or romiplostim for chronic immune idiopathic thrombocytopenic purpura.

Download and complete the Idiopathic thrombocytopenic purpura - eltrombopag or romiplostim - first continuing or re-initiation of interrupted 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: 26 September 2022