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About Us
Our Services
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Residential Aged Care
Respite Care
Dementia & Memory Support
Our Features
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Our Care
Our Facilities
Our Activities
Our Food
Our Safety Measures
Our Pricing
Connect
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Manorisms – Meet Our Residents
Get Involved
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Nominated Representative
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*
First Name
Surname Name
*
Phone
Mobile & After Hours
Address
Street Address
Relationship to applicant
Email
Power of Attorney
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*
First Name
Surname Name
*
Address
Street Address
Phone
Mobile & After Hours
Relationship to applicant
Email
Authority Held
Max. file size: 300 MB.
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General Health & Benefits
Pension Card Number
Expiry Date
MM slash DD slash YYYY
Medicare Card Number
Expiry Date
DD slash MM slash YYYY
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Max. file size: 300 MB.
Please provide a copy of your pension and medicare cards
Private Health & Benefits
Name of Health Fund
Membership Number
Level of Cover
Ambulance Membership Number
Diabetes Membership Number
Title
First Name
Surname Name
Address
Street Address
Phone
Mobile & After Hours
Email
Name Current or Previous Aged Care Home
Address
Street Address
Director of Nursing's Name
Contact Number
Director of Nursing's Name
Contact Number
Date you entered the facility
DD slash MM slash YYYY
Date you departed the facility
DD slash MM slash YYYY
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