PBS Safety Net claim for payment form (PB241)

Use this form if you are an approved supplier claiming a payment for issuing a PBS Safety Net card.

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

PBS is the Pharmaceutical Benefits Scheme.

We require you to keep a copy of the completed form that you submit to us for your records.

We will only accept typed claim forms. We will return handwritten, incomplete or poor quality forms to the pharmacy.

Page last updated: 5 July 2023.
QC 46956