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.


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 either the PDF or Word version by:

  • Saving the PDF to your hard drive and opening it with your PDF software. You can then type into the fields before printing, signing and returning to us.
  • Downloading and printing the Word version. You can fill it out by hand, sign and return 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:
Last updated:
Publication type:
Health sector

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.

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