Get Au Health03pbs 2021-2025

The AU HEALTH03PBS form is essential for pharmacy owners seeking to authorize individuals to act on their behalf regarding pharmaceutical benefit claims. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the AU HEALTH03PBS form.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin by filling in your details as a business owner. Include the relevant information such as your title (Dr, Mr, Ms, Other), family name, and first given name. Ensure that all business owners are accounted for.
3. Provide the details of the approved pharmacy premises, including the PBS approval number, pharmacy business (trading) name, and the address of the approved pharmacy premises.
4. List the persons who are permitted to act on behalf of the approved pharmacist(s). For each permitted person, select their role (Pharmacy staff or Pharmacist), and fill in their family name, first given name, registration number, and signature.
5. If there are more than four permitted persons, attach a separate sheet with their details.
6. Provide contact details for the person the Department of Health should contact regarding this form, including their title, family name, first given name, and position in the organization.
7. Complete the declaration section, ensuring it is signed and dated by one of the business owners listed in the form.
8. Verify that all required questions are answered before returning the form via the PBS Approved Suppliers Portal. Remember, emailing the form is not permitted.
9. Finally, save changes, download, print, or share the form as needed.

Complete your documents online today for a smooth submission process.