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
2639XMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT METHIONINE amino acid formula with vitamins and minerals without methionine oral liquid, 30 x 87 mL sachets (PI, CMI)	4	4	5	$1369.50	$30.00	$30.00
	Available brands
	HCU cooler 10

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
2640YMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT METHIONINE amino acid formula with vitamins and minerals without methionine oral liquid, 30 x 174 mL sachets (PI, CMI)	4	4	5	$3358.30	$30.00	$30.00
	Available brands
	HCU cooler 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
8677QMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT METHIONINE amino acid formula with vitamins and minerals without methionine powder for oral liquid, 30 x 24 g sachets (PI, CMI)	4	4	5	$1369.50	$30.00	$30.00
	Available brands
	HCU gel

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
8744FMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT METHIONINE amino acid formula with vitamins and minerals without methionine powder for oral liquid, 30 x 25 g sachets (PI, CMI)	4	4	5	$2559.06	$30.00	$30.00
	Available brands
	HCU express 15

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
9133QMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT METHIONINE amino acid formula with vitamins and minerals without methionine oral liquid, 30 x 130 mL pouches (PI, CMI)	4	4	5	$2022.22	$30.00	$30.00
	Available brands
	HCU cooler 15