If you require assistance, please call 1800 317 009. Step 1 of 5 Facility Details Facility Name * AnglicareSA Westbourne Park AnglicareSA Elizabeth East AnglicareSA Elizabeth - Dutton Court AnglicareSA Trott Park AnglicareSA Grange AnglicareSA Brompton Applicant Details Title First Names * Last Name * Gender Male Female Date of Birth * Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Next Step 2 of 5 Are you applying for? Permanent Entry Respite Care Previous Next Step 3 of 5 Aged Care Assessment Team (ACAT) Have you had an ACAT assessment? Yes No An ACAT assessment is required to complete your application. Please call my aged care on 1800 200 422 or visit myagedcare.gov.au. ACAT assessment document Select FileNo file selected Do you have a copy of the Aged Care Client Record? Which of the following have you been approved? Permanent Respite Care Previous Next Step 4 of 5 Care Requirements Shared Room Acceptable Private Room Previous Next Step 5 of 5 Person who should be contacted regarding this application The contact person is Nominated Person Other First Name * Surname * Relationship to Applicant * Daytime Phone * Mobile Phone Enduring Power of Attorney Enduring Power of Guardian Address Line 1 * Address Line 2 Suburb * State * SA ACT NSW NT QLD VIC WA Postcode * Email * Other Additional Comments Previous Submit Thank you, your details have been submitted successfully.
