Application for Admission

    The primary purpose of this form is to assess the suitability of both the individual and our facility to ensure a harmonious fit for both parties.
    By gathering essential information, we aim to understand the specific care needs and preferences of the potential resident. This initial inquiry stage helps us ensure that we can meet those needs effectively and provide the highest quality of care.
    It's important to emphasize that completing this enquiry form does not constitute an application for admission. Instead, should the enquiry progress to the next stage, a comprehensive application for admission will be required to initiate the formal process of joining our residential care community.
    We value transparency and want to ensure that individuals and their families have all the necessary information to make informed decisions about their aged care journey.

    - - -
    Complete the following for the individual requiring care:

    Full Name of individual requiring care:
    Enquiring About:
    Street Address:
    Contact Number:
    Country of Birth:
    Languages Spoken:
    Family Status:
    Current living situation:

    - - -
    It is the policy of Allambie Heights Village Ltd. that we request you to provide details regarding your assets and income if you are applying for placement in the Residential Aged Care Facility. Please complete to the best of your knowledge however should you wish for your application to progress; more accurate details will need to be provided at a later date.

    - - -
    Current residential status:
    Estimated Value of home:
    Does a partner, dependent child or eligible carer determined by the Department of Human Services or Department of Veteran Affairs live in this house?
    Do you currently receive the pension?
    Estimated Bank Deposits and Cash:
    Estimated Value of Investment property:
    Estimated value of all other assets: (Shares etc.)
    Estimated Total Value of Assets:
    Estimated Liabilities, (Loans etc):
    Estimated Total Annual Income:

    It's crucial to maintain transparency and confidentiality throughout the assessment process. Rest assured that all information provided in this enquiry form will be kept confidential and will not be shared with any third parties. Our primary objective is to gather data for the assessment of suitability for both the individual and our facility.

    Furthermore, if the assessment results in the approval of care, the next step will require you to complete the current Permanent Residential Aged Care Request for a Combined Assets & Income Assessment Form. This form needs to be submitted to either the Department of Human Services or the Department of Veterans Affairs, depending on your specific circumstances. This step is essential for residents to determine their eligibility for government assistance with their care and accommodation costs. Once the assessment is complete, a statement will be provided to the resident, which can then be shared with us as part of the formal admission process. This ensures a seamless transition into our care community while addressing any financial assistance needs that may arise.

    - - -
    I have been assessed by the Aged Care Assessment Team (ACAT):
    Month/Year Assessed:
    Aged Care ID:
    Residential Respite Referral Code:
    Residential Permanent Referral Code:

    - - -
    Carer/Relative/Point of Contact Information:
    Full Name:
    Relationship to applicant:
    Contact Number:
    Do you have Power of Attorney?
    Are you Enduring Guardian?: