Aged care application for the dementia and cognition supplement in home care form (AC014)

Use this form to advise us that a care recipient within your aged care service is eligible to receive the Dementia and Cognition Supplement.

An authorised person of the approved provider must complete and sign this form.

This PDF is fillable. Download this form and complete it on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, there are other ways you can do your business with us. You can use self service or request someone to deal with us on your behalf. If you can’t access our forms, please contact us. We can help you access, complete and submit them.

Page last updated: 6 May 2019

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