Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
12273YMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT METHIONINE amino acid formula with vitamins and minerals without methionine powder for oral liquid, 30 x 29 g sachets (PI, CMI)	4	4	5	$3359.96	$31.60	$31.60
	Available brands
	HCU Lophlex

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
1548LMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT METHIONINE amino acid formula with vitamins and minerals without methionine oral liquid, 30 x 125 mL pouches (PI, CMI)	3	3	5	$2560.68	$31.60	$31.60
	Available brands
	HCU Lophlex LQ 20

Source	General Schedule
Body System	VARIOUS > GENERAL NUTRIENTS > OTHER NUTRIENTS

Restricted Benefit

Code & Prescriber	Medicinal Product Pack (Name, form & strength and pack size)	Max qty packs	Max qty units	No. of repeats	DPMQ	Max Safety Net	General Patient Charge
8417BMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT METHIONINE amino acid formula with vitamins and minerals without methionine powder for oral liquid, 400 g (PI, CMI)	8	8	5	$634.40	$31.60	$31.60
	Available brands
	HCU Anamix infant