Atypical haemolytic uraemic syndrome (aHUS) - eculizumab or ravulizumab - continuing authority application form (PB125)

Use this form to apply to continue PBS-subsidised treatment with eculizumab or ravulizumab for aHUS.

Download and complete the atypical haemolytic uraemic syndrome (aHUS) - eculizumab or ravulizumab - continuing authority application form.

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.

You can upload this form in HPOS.

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Page last updated: 1 January 2024.
QC 21451