Health professionals forms by code

Forms listed by code for health professionals, practice staff and pharmacy assistants.

Code Title
AC001 Aged Care Funding Instrument - Application for classification
AC004 Aged Care Provider Portal - register, amend or remove users
AC010 Consent to release an electronic Aged Care Client Record
AC011 Application for the oxygen and/or enteral feeding supplement
AC014 Aged care application for the dementia and cognition supplement in home care
AC015 Application to add or change approved care service's bank details
AC021 Aged care entry record
AC024 Viability expansion component and homeless supplement assessment
AC027 Register or update for Aged Care web services
DB018 Application for bulk bill claim adjustment
DB020 Assignment of benefit Medicare bulk bill Webclaim
DB4E Bulk bill voucher - electronically transmitted claims
DB6Ba Medicare stationery order
HW003 Request to renew, revoke or reissue a Public Key Infrastructure certificate
HW009 Application for approval, amendment or renewal of an approved pathology practitioner
HW010 Application for approval, amendment or renewal of premises as an accredited pathology laboratory
HW011 Application for approval, amendment or renewal of an approved pathology authority
HW012 HI Service - My Health Record system - application to register a contracted service provider organisation record
HW013 HI Service - application to register a general supporting organisation
HW019 Application for a Medicare provider number and/or prescriber number for a medical practitioner
HW023 Simplified Billing or ECLIPSE adjustment claim
HW026 Application for late lodgement of a Simplified Billing claim for assigned Medicare benefits
HW027 Online claiming provider agreement
HW029 Provider registration for Electronic Funds Transfer payments
HW034 HI Service - application to amend a healthcare provider record
HW035 Application for approval, amendment, renewal or cancellation of an approved collection centre
HW036 Approved Pathology Authority acquisition or merger advice
HW042 HI Service - application to amend an organisation officer's personal details
HW043 HI Service - application to amend details of a contracted service provider organisation record
HW044 HI Service - application to deactivate, reactivate or retire a healthcare organisation
HW046 HI Service - application to add, replace or remove a contracted service provider officer
HW047 HI Service - application to amend a contracted service provider officer's details
HW048 Healthcare Identifiers Service application to deactivate or retire a contracted service provider organisation
HW052 Banking details online claiming
HW055 Notification of Australian Business Number and reference identification for tax treatment purposes and recipient created tax invoice agreement
HW059 Medicare Easyclaim enquiry
HW061 Application to register or amend a diagnostic imaging or radiation oncology practice
HW064 Positron emission tomography - statutory declaration
HW065 Application for remote area exemption for R-type diagnostic imaging services for a medical practitioner
HW074 General practitioner 90 day pay doctor cheque scheme application
HW077 Application for recognition as a specialist or consultant physician
HW078 Request for pay group link
HW080 Manual identity verification for Provider Digital Access
HW081 Private health insurer registrations and updates for ECLIPSE
HW083 Request to revoke or reissue a NASH PKI certificate
HW088 Application for a Medicare provider number and/or prescriber number for a nurse practitioner or midwife
HW091 Simplified Billing manual claims batch header
HW093 Application for a Medicare provider number and, or prescriber number for allied health and non-medical health professionals
IM004 Australian Immunisation Register (AIR) - application to register as a vaccination provider
IM005 Australian Immunisation Register (AIR) - bank account details for vaccination providers
IM011 Australian Immunisation Register (AIR) - immunisation medical exemption
IM013 Australian Immunisation Register (AIR) - immunisation history
IM017 Australian Immunisation Register (AIR) - ceasing correspondence and release of information
IM018 Australian Immunisation Register (AIR) - immunisation encounter
IP001 Practice Incentives application
IP003 Practice Incentives individual general practitioner or nurse practitioner details
IP004 Practice Incentives Program Procedural General Practitioner Payment application
IP005 Practice Incentives change of practice details
IP006 Practice Incentives Program Teaching Payment claim
IP007 Practice Incentives Practice closure or withdrawal
IP008 Practice Incentives practice ownership details and declaration
IP010 Practice Incentives Change of practice ownership
IP017 Practice Incentives Program Indigenous Health Incentive patient registration and consent
IP020 Workforce Incentive Program - Doctor Stream - bank account details
IP025 Practice Incentives Additional practice branch
IP026 Practice Incentives Program Indigenous Health Incentive practice application
IP027 Practice Incentives review of decision
IP029 Practice Incentives Program Indigenous Health Incentive patient withdrawal of consent
IP030 Practice Incentives Program After Hours Incentive application
IP034 MyMedicare Incentives Review of decision
MO003 Application for an authorised recipient to apply for or renew access to the Provider Directory System
MO008 Medical indemnity request to aggregate payments for the same claim
MO031 Statutory declaration ROCS - Medical practitioner who has ceased private or all remunerated medical practice due to retirement
MO032 Run off Cover Indemnity Scheme - medical certificate maternity
MO033 Statutory declaration ROCS - Deceased medical practitioner
MO034 Statutory declaration ROCS - Medical practitioner who has not engaged in either private or remunerated medical practice during the preceding 3 years
MO035 Statutory declaration ROCS - Overseas medical practitioner
MO036 Statutory declaration ROCS - Medical practitioner who has ceased medical practice because of permanent disability
MO037 Statutory declaration ROCS - Medical practitioner who has ceased medical practice because of maternity
MO038 Statutory declaration ROCS - Midwife ceased practice because of permanent disability
MO039 Statutory declaration ROCS - Midwife who has ceased practice
MO040 Statutory declaration ROCS - Deceased midwife
MO041 Statutory declaration ROCS - Midwife who has ceased practice because of maternity
MO042 Statutory declaration - Midwife Professional Indemnity Scheme - Online claim
MO043 ROCS - midwife medical certificate for maternity
MO044 Statutory declaration ROCS - Midwife who has not engaged in a private practice during the preceding 3 years
MO056 Run off Cover Indemnity Scheme - medical certificate permanent disability
MO057 Voluntary acknowledgement of incorrect payments
MO060 ROCS - midwife medical certificate for permanent disability
MO065 COVID-19 Vaccine Claims Scheme cost calculation
MS040 Request for Pharmaceutical Benefits Scheme claims information
PB012 Myelodysplastic syndrome - lenalidomide - initial or first continuing authority application
PB019 Notification of bank account details for Aboriginal Health Services program payments
PB042 Remote Area Aboriginal Health Services request and claim
PB062 Juvenile idiopathic arthritis - for adult patients with onset prior to age 18 - initial authority application
PB063 Juvenile idiopathic arthritis - for adult patients with onset prior to age 18 - continuing authority application
PB070 Pulmonary arterial hypertension - initial monotherapy authority application
PB072 Subfoveal choroidal neovascularisation - initial authority application
PB073 Ankylosing spondylitis - initial authority application
PB074 Ankylosing spondylitis - continuing authority application
PB075 Severe asthma - adolescent and adult - initial or recommencement after 12 months break authority application
PB076 Severe asthma - adolescent and adult - continuing authority application
PB077 Acute lymphoblastic leukaemia second line - dasatinib - initial authority application
PB079 Chronic myelomonocytic leukaemia - azacitidine - initial authority application
PB084 Chronic myeloid leukaemia - asciminib or ponatinib - continuing authority application
PB085 Crohn's disease paediatric - initial authority application
PB087 Crohn’s disease adult - initial authority application
PB088 Crohn’s disease adult - continuing authority application
PB092 Fistulising Crohn's disease - initial or recommencement (treatment break greater than 5 years) authority application
PB093 Fistulising Crohn's disease - continuing authority application
PB096 Gastrointestinal stromal tumour - sunitinib - initial authority application
PB097 Idiopathic thrombocytopenic purpura - initial authority application
PB099 Metastatic HER2 positive breast cancer - lapatinib - initial authority application
PB104 Narcolepsy without cataplexy - armodafinil or modafinil - initial authority application
PB105 Psoriatic arthritis - initial authority application
PB106 Psoriatic arthritis - continuing authority application
PB109 Rheumatoid arthritis - initial authority application
PB111 Rheumatoid arthritis - continuing authority application
PB112 Severe chronic plaque psoriasis - initial authority application
PB113 Severe chronic plaque psoriasis - continuing authority application
PB114 PASI calculation and body diagram - face, hand and foot
PB115 PASI calculation and body diagram - whole body
PB119 Atypical haemolytic uraemic syndrome (aHUS) - eculizumab or ravulizumab - initial or switching authority application
PB120 Cystic fibrosis - ivacaftor - initial authority application
PB123 CD30 positive systemic anaplastic large cell lymphoma - brentuximab vedotin - initial authority application
PB125 Atypical haemolytic uraemic syndrome (aHUS) - eculizumab or ravulizumab - continuing authority application
PB126 Cystic fibrosis - ivacaftor - continuing authority application
PB127 Ulcerative colitis adult - initial authority application
PB136 Seemingly valid Medicare card
PB154 Retinal vein occlusion - initial authority application
PB155 Diabetic macular oedema - initial authority application
PB156 Non-small cell lung cancer - crizotinib or entrectinib - initial authority application
PB157 Request for prescriber bag supplies order book
PB158 Multiple myeloma progressive disease - lenalidomide - initial authority application
PB161 Crohn's disease paediatric - continuing authority application
PB162 Growth hormone paediatric - initial authority application
PB163 Growth hormone paediatric - continuing authority application
PB164 Growth hormone paediatric - continuing as a reclassified patient authority application
PB165 Growth hormone paediatric - change or recommencement authority application
PB166 Growth hormone paediatric - recommencement as a reclassified patient authority application
PB169 Acute lymphoblastic leukaemia - ponatinib initial authority application
PB171 Chronic myeloid leukaemia - asciminib or ponatinib - initial authority application
PB172 Myelofibrosis - ruxolitinib - initial authority application
PB176 Atypical haemolytic uraemic syndrome (aHUS) - eculizumab or ravulizumab - recommencement authority application
PB181 Acromegaly - pasireotide - initial authority application
PB188 Severe allergic asthma paediatric - omalizumab - initial authority application
PB192 Chronic thromboembolic pulmonary hypertension - riociguat - initial authority application
PB200 Multiple myeloma newly diagnosed dual therapy - lenalidomide - initial authority application
PB205 Relapsed or refractory Hodgkin lymphoma - brentuximab vedotin - initial authority application
PB206 Metastatic or locally advanced basal cell carcinoma - sonidegib or vismodegib - initial authority application
PB207 Metastatic or locally advanced basal cell carcinoma - sonidegib or vismodegib - continuing authority application
PB208 Idiopathic pulmonary fibrosis - initial authority application
PB210 Acute lymphoblastic leukaemia - blinatumomab - initial (induction) authority application
PB214 Multiple myeloma dual therapy - pomalidomide - initial authority application
PB215 Ulcerative colitis - paediatric - initial authority application
PB216 Cutaneous T-cell lymphoma (CTCL) - vorinostat - initial authority application
PB218 Moderate to severe hidradenitis suppurativa - initial, change or recommencement authority application
PB219 Moderate to severe hidradenitis suppurativa - continuing authority application
PB223 Severe chronic spontaneous urticaria - omalizumab - initial authority application
PB225 Acromegaly - pegvisomant - initial authority application
PB229 Order for PBS computer prescription forms for all eligible prescribers
PB233 Spinal muscular atrophy paediatric - nusinersen or risdiplam - initial authority application
PB235 Crohn’s disease adult - change, recommencement or demonstration of response authority application
PB236 Fistulising Crohn’s disease - change, recommencement (treatment break less than 5 years) or demonstration of response authority application
PB239 Crohn's disease paediatric - change, recommencement or demonstration of response authority application
PB241 PBS Safety Net claim for payment
PB242 Approved supplier manual payment reconciliation
PB243 Cystic fibrosis - lumacaftor+ivacaftor or tezacaftor+ivacaftor - initial authority application
PB244 Cystic fibrosis - lumacaftor+ivacaftor or tezacaftor+ivacaftor - continuing authority application
PB245 Ulcerative colitis adult - change or recommencement authority application
PB246 Ulcerative colitis paediatric - change or recommencement authority application
PB247 Rheumatoid arthritis - change, recommencement or demonstration of response authority application
PB248 Growth hormone deficiency - late onset initial authority application
PB251 Ankylosing spondylitis - change, recommencement or demonstration of response authority application
PB253 Acute myeloid leukaemia - midostaurin - initial maintenance authority application
PB255 Non-radiographic axial spondyloarthritis - initial authority application
PB259 Manual Prescription processing fee
PB260 Psoriatic arthritis - change, recommencement or demonstration of response authority application
PB263 Severe chronic plaque psoriasis - change, recommencement or demonstration of response authority application
PB268 Cutaneous T-cell lymphoma (CTCL) - brentuximab vedotin - initial authority application
PB269 Acute lymphoblastic leukaemia - inotuzumab ozogamicin initial (induction) authority application
PB271 Acute lymphoblastic leukaemia first line - dasatinib - initial (induction and consolidation) authority application
PB272 Giant cell arteritis - tocilizumab - initial authority application
PB275 Short bowel syndrome with intestinal failure - teduglutide - initial authority application
PB276 Short bowel syndrome with intestinal failure - teduglutide - continuing authority application
PB282 Juvenile idiopathic arthritis - for adult patients with onset prior to age 18 - change or recommencement authority application
PB283 Order for PBS prescription pads for all eligible prescribers
PB285 Severe asthma - adolescent and adult - change authority application
PB286 Cystic fibrosis - elexacaftor+tezacaftor+ivacaftor - initial authority application
PB287 Cystic fibrosis - elexacaftor+tezacaftor+ivacaftor - continuing authority application
PB288 Growth hormone deficiency - childhood onset initial authority application
PB289 Early HER2 positive breast cancer - trastuzumab emtansine - initial authority application
PB291 Multiple myeloma newly diagnosed monotherapy - lenalidomide - initial authority application
PB293 Multiple myeloma newly diagnosed triple therapy - lenalidomide - initial authority application
PB294 General (S85) Schedule - opioid treatment authority application
PB302 Medicine export declaration
PB303 Pulmonary arterial hypertension - initial dual or triple therapy authority application
PB306 Palliative Care Schedule - opioid treatment authority application
PB314 Peripheral T-cell lymphoma (PTCL) - brentuximab vedotin - initial authority application
PB319 Severe chronic plaque psoriasis paediatric - ustekinumab - continuing authority application
PB320 Severe chronic plaque psoriasis paediatric - ustekinumab - initial, change, recommencement or demonstration of response authority application
PB323 Juvenile idiopathic arthritis - change of treatment after resolution of critical shortage of tocilizumab authority application
PB324 Rheumatoid arthritis - change of treatment after resolution of critical shortage of tocilizumab authority application
PB325 Hereditary angioedema type 1 or 2 - lanadelumab - initial authority application
PB327 Paroxysmal nocturnal haemoglobinuria - eculizumab or ravulizumab - initial, switching, returning or balance of supply authority application
PB328 Paroxysmal nocturnal haemoglobinuria - eculizumab or ravulizumab - continuing authority application
PB329 Paroxysmal nocturnal haemoglobinuria - eculizumab or ravulizumab - initial grandfather authority application
PB330 Spinal muscular atrophy - onasemnogene abeparvovec - authority application
PB332 Progressive fibrosing interstitial lung disease - nintedanib - initial authority application
PB333 Solid tumours with confirmed NTRK gene fusion - larotrectinib - initial authority application
PB334 Spinal muscular atrophy adult - nusinersen or risdiplam - initial authority application
PB336 Severe growth failure with primary insulin-like growth factor-1 deficiency - mecasermin - initial authority application
PB337 Severe growth failure with primary insulin-like growth factor-1 deficiency - mecasermin - continuing authority application
PB339 Growth hormone paediatric - somatrogon - initial grandfather authority application
PB340 Chronic myelomonocytic leukaemia - decitabine+cedazuridine - initial authority application
PB341 Systemic light chain amyloidosis newly diagnosed - daratumumab - initial authority application
PB343 Paroxysmal nocturnal haemoglobinuria - pegcetacoplan - initial authority application
PB344 Paroxysmal nocturnal haemoglobinuria - pegcetacoplan - continuing or returning authority application
PB348 Chronic rhinosinusitis with nasal polyps - mepolizumab - initial authority application
PB352 Ankylosing spondylitis - bimekizumab - initial grandfather authority application
PB353 Non-radiographic axial spondyloarthritis - bimekizumab - initial grandfather authority application
PB354 Resubmit rejected items for Remote Area Aboriginal Health Services claim
PB355 Acute myeloid leukaemia - oral azacitidine - dose escalation therapy continuing authority application
PB358 Transthyretin amyloid cardiomyopathy - tafamidis - initial authority application
PB359 Atypical haemolytic uraemic syndrome (aHUS) - ravulizumab - initial grandfather authority application
PB360 Symptomatic obstructive hypertrophic cardiomyopathy - mavacamten - initial authority application
PB361 Symptomatic obstructive hypertrophic cardiomyopathy - mavacamten - initial grandfather authority application
PB362 Severe aplastic anaemia - eltrombopag - initial authority application
PB363 Severe aplastic anaemia - eltrombopag - initial grandfather authority application
PB364 Moderate to severe hidradenitis suppurativa - secukinumab - initial grandfather authority application
PB365 Systemic lupus erythematosus - anifrolumab - initial authority application
PB366 Systemic lupus erythematosus - anifrolumab - initial grandfather authority application
PB367 Hereditary transthyretin amyloidosis - patisiran - initial authority application
PB368 Hereditary transthyretin amyloidosis - patisiran - continuing authority application
PB369 Hereditary transthyretin amyloidosis - patisiran - initial grandfather authority application
PB370 Neurofibromatosis type 1 - selumetinib - initial authority application
PB371 Neurofibromatosis type 1 - selumetinib - initial grandfather authority application
PB372 Non-infectious uveitis - adalimumab - initial authority application
PB373 Fabry disease - migalastat - initial authority application
PB374 Fabry disease - migalastat - initial grandfather authority application
PB375 Psoriatic arthritis - bimekizumab - initial grandfather authority application
PB376 Ulcerative colitis - etrasimod - initial grandfather authority application
PB377 Subfoveal choroidal neovascularisation - aflibercept - initial grandfather authority application
PB378 Diabetic macular oedema - aflibercept - initial grandfather authority application
PB379 Chronic pouchitis - vedolizumab - initial or recommencement authority application
PB380 Chronic pouchitis - vedolizumab - initial grandfather authority application
SA478 Disability Support Pension Medical Evidence Checklist for treating health professionals
SA495 Verification of Terminal Illness
SU415 Centrelink Medical Certificate
Page last updated: 18 October 2024.
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