Short bowel syndrome with intestinal failure initial PBS authority application form (PB275)

Use this form to apply for initial subsidised teduglutide treatment for short bowel syndrome with intestinal failure.

Download and complete the Short bowel syndrome with intestinal failure initial PBS authority application form (PB275).

This form can be uploaded through HPOS. Read more about form upload in HPOS.

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.

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Page last updated: 3 March 2022