Seemingly valid Medicare card form (PB136)

Use this form if you are a pharmacist who has previously submitted a PBS or RPBS claim to us which has been rejected based on the patients Medicare card number.

Download and complete the Seemingly valid Medicare card form.

Complete this form for your patient if we found that the Medicare or Repatriation card details were invalid, and they have presented another script and cannot provide an alternative Medicare or Repatriation card details.

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.

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: 28 July 2022