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
2474FMPNP	AMINO ACID FORMULA WITH VITAMINS AND MINERALS WITHOUT PHENYLALANINE amino acid formula with vitamins and minerals without phenylalanine oral liquid, 30 x 174 mL pouches (PI, CMI)	4	4	5	$1692.27	$31.60	$31.60
	Available brands
	PKU Cooler 20