Life Saving Drugs Program – Change of treating physician form

Use this form to help transition a patient’s care to a new physician, where there are no other changes to their treatment or eligibility for the Life Saving Drugs Program (LSDP).


Life Saving Drugs Program – Change of treating physician form

We are working to improve this form, which currently does not display correctly in all web browsers. In the meantime:

  1. save the PDF to your hard drive
  2. open it with your PDF software
  3. type into the fields before signing and returning to us.

We aim to provide documents in an accessible format. If you're having problems using a document with your accessibility tools, please contact us for help.

Publication date:
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Health sector

This form is for the new treating physician to complete when:

  • a patient receiving LSDP medicine transfers into their care
  • there are no changes to the patient’s treatment or eligibility information.

The patient (or their parent or guardian) must also sign the form to provide consent to us to collect personal information.

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If you would like a response please use the enquiries form instead.