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Signature of approved provider or authorised agent Date Note The Aged Care Act 1997 provides penalties for the provision of false or misleading information on this form. Section 4 For office use only Rejection Code Keyed initials Publication Date 2 July 2007 Mental and Behavioural Diagnosis Indicate which sources of evidence have been filed in the ACFI Appraisal Pack Tick if yes Aged Care Client Record ACCR D1. 1 GP comprehensive medical assessment D1. 2 General medical practitioner notes or le ...

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