Consent to release an electronic Aged Care Client Record form (AC010)

Use this form to prove that a care recipient or nominee has consented that an aged care service or Aged Care Assessment Team can request a copy of their electronic Aged Care Client Record.

Download and complete the Consent to release an electronic Aged Care Client Record form.

Aged care services include Residential care, Home care and Multi Purpose Services.

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: 28 January 2020