IPU Application Form – Fillable PDF

The IPU (Individual Patient Use) Application Form is required by hospitals and health‑care providers in Australia when seeking approval to use a medicine on a single patient outside of clinical trials. This form collects detailed clinical information, justification, and safety considerations.

What Is the IPU Application Form?

The form is a government‑endorsed document used by the New South Wales Therapeutic Advisory Group (NSW TAG). It ensures that the proposed use of an unapproved or restricted medication is medically justified and that patient safety is protected.

How to Fill Out the Form Online

Instead of downloading the PDF and opening it in a separate editor, simply click the "Fill out this form" button on the page. The Formize PDF Filler app will load directly in your browser, letting you complete every field instantly.

Common Mistakes to Avoid

• Leaving any required field blank – the filler will highlight missing information.
• Using non‑standard abbreviations for drug names or dosage.
• Failing to attach supporting clinical documents (lab reports, consent forms).
• Submitting the form without a final review – errors can delay approval.

Where to Submit the Completed Form

Once all sections are completed and reviewed, download the signed PDF and email it to ipu@nswtag.org.au or upload it through the NSW TAG online portal. Keep a copy for your records.

Download the Fillable PDF

If you prefer to work offline, you can download the official fillable PDF below. The file is hosted by NSW TAG and is fully compatible with Formize.

Download IPU Application Form (PDF)