Get Au Pb065 2015-2025

This guide provides a comprehensive step-by-step approach to filling out the AU PB065 online, designed to assist users in completing their authority application for for BH4 deficiency. Whether you are applying for initial or continuing treatment, this guide aims to streamline the process for you.

Follow the steps to complete your authority application

1. Click the ‘Get Form’ button to obtain the AU PB065 form and open it in your digital environment.
2. Begin by entering the patient’s details, including their Medicare card number or Department of Veterans’ Affairs card number, followed by their full name and date of birth.
3. In the conditions and criteria section, indicate if the patient has hyperphenylalaninaemia due to BH4 deficiency by selecting the appropriate option.
4. Fill in the patient’s weight and the required dose in mg/kg, ensuring the information is accurately provided.
5. For prescriber details, provide the prescriber number, full name, business phone number, and any alternative contact number.
6. Complete the prescriber’s declaration by confirming that the information provided is complete and correct, followed by signing and dating the form.
7. Ensure that all applicable pathology reports and a completed authority prescription form are attached to the application.
8. Review the entire form for completeness and accuracy. Once satisfied, save the changes, download the form, print it for submission, or share it electronically, if applicable.

Complete your AU PB065 authority application online today.