Aged care entry record form (AC021)

Use this form to tell the us that a care recipient has entered either permanent residential care or commenced receiving a Home Care Package on or after 1 July 2014.

An authorised person of the approved provider must complete and sign this form within 28 days of the care recipient’s entry or commencement date.

This information will not need to be provided again in the monthly claim form, unless the care recipient’s circumstances change.

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

Page last updated: 13 November 2018