Life Saving Drugs Program – Hereditary tyrosinaemia (type 1) – Initial application

Treating physicians use this application form to apply for a patient to access LSDP medication for hereditary tyrosinaemia (type 1) for the first time, or after a break.

Downloads

Life Saving Drugs Program – Hereditary tyrosinaemia (type 1) – Initial application

We are working to improve this form, which currently does not display correctly in all web browsers. In the meantime, you can use the PDF version by:

  • Saving the PDF to your hard drive and opening it with your PDF software. Right-click on the Download link and select 'Save link as', then choose a destination on your device to save the file.
  • You can then type into the fields before printing, 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:
Date last updated:
Publication type:
Form
Audience:
Health sector
Language:
English
Description:

This form includes:

  • information about the application process and timelines
  • treating physician's responsibilities
  • privacy notice and patient consent
  • health professional details
  • dosing details
  • eligibility requirements and test results
  • treating physician's declaration
  • application checklist.

Help us improve health.gov.au

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