Professional Documents
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Pbs Form
Pbs Form
PB229.2005 1 of 2
Order for PBS computer prescription
forms for all eligible prescribers (PB229)
servicesaustralia.gov.au/privacy
3 Provider number
Declaration
4 Select quantity of cartons required according to your prescriber
7 I declare that:
type
• this form is submitted on behalf of and with the
Medical Practitioner authorisation of the prescriber identified above.
2000 forms per carton 1 2 3
• the information I have provided in this form is complete and
Nurse Practitioner or Midwife correct.
1000 forms per carton 1 2 I understand that:
Optometrist • if this form is handwritten, incomplete or poor quality, it will
1000 forms per carton 1 be returned to me.
• the information I have provided in this form will be supplied
Dental Practitioner
1 securely to Services Australia.
500 forms per carton
• giving false or misleading information is a serious offence.
5 Delivery address (must be recorded with us) Prescriber’s name or name of person placing the order
Prescriber full name
Date
Practice name Reset form Print form
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PB229.2005 2 of 2