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. You can fill it out on your device, or print it and complete it by hand.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.

Page last updated: 17 May 2021