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.

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.

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