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

Note

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
12456NMPNP	HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATE high fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate (4:1 ratio medium chain fat to carbohydrate plus protein) oral liquid, 30 x 250 mL cartons (PI, CMI)	6	6	5	$1360.77	$31.60	$31.60
	Available brands
	KetoVie 4:1

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

Note

Authority Required

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
12789DMPNP	HIGH FAT FORMULA WITH VITAMINS, MINERALS AND TRACE ELEMENTS AND LOW IN PROTEIN AND CARBOHYDRATE high fat formula with vitamins, minerals and trace elements and low in protein and carbohydrate (4:1 ratio medium chain fat to carbohydrate plus protein) oral liquid, 30 x 250 mL cartons (PI, CMI)	6	6	5	$1540.41	$31.60	$31.60
	Available brands
	KetoVie Peptide 4:1