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.

You must download our forms to fill them in. We have help available if you use assistive technology or if you need a translator or interpreter. Find out how to use our forms.

Download and complete the Aged care entry record form.

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.

Page last updated: 19 November 2025.
QC 21466