Request for prescriber bag supplies order book form (PB157)

Use this form to order the Prescriber bag supplies order book to get some PBS medicines to give to patients for emergency use if you are an eligible prescriber.

Download and complete either the Word or PDF version of the:

We will only accept typed prescription order forms. We will return handwritten, incomplete or poor quality forms to the prescriber.

PBS is the Pharmaceutical Benefits Scheme. 

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: 3 March 2022