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.

Download and complete the Aged care application for the dementia and cognition supplement in home care form.

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

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: 8 December 2020