• Request for adrenaline autoinjector

    Clinical agreement by Immunologist/Allergist
  • Request for clinical agreement by Clinical Immunologist / Allergist for PBS Authority prescription of an adrenaline autoinjector

    Please refer to the ASCIA adrenaline autoinjector prescription guidelines on the ASCIA website: https://www.allergy.org.au/hp/anaphylaxis/adrenaline-autoinjector-prescription

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  • Patient Details

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  • NB. Decisions about patient advice on adrenaline autoinjectors and instructions for use remain the responsibility of the prescribing doctor.

     

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    The Immunologist/Allergist at Compass Immunology Clinic will complete the next section.

     

  •  For completion by the clinical immunologist / allergist

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