Other Time returned In relation to the circumstances resulting in the Surname unexplained absence of this care recipient, what action has been taken to manage or minimise the risk of the unexplained absence occurring again? Given name Position/role (e.g. CEO, key personnel, registered If the care recipient is still missing from the nurse, etc.) service, what action is being taken to locate the care recipient? Work number (include area code) Statement I declare that the information I have provided in Mobile number this form is complete and correct. Your Name Email address Date Note: A departmental officer may contact you to seek further information in relation to this report. Approved provider and service details Name of the aged care service this report relates to: RACS ID: Name of the approved provider this report relates to: Unexplained Absence details Has the unexplained absence of the care recipient been reported to the police? Yes provide details below No go to question 12 Date reported to police Time reported to police Police station reported to (if applicable) Incident number Has the care recipient returned to the service? Yes provide details below No report unexplained absence to police Date returned
Other Surname Given name Position/role (e.g. CEO, key personnel, registered nurse, etc.) Work number (include area code) Mobile number Email address Note: A departmental officer may contact you to seek further information in relation to this report. Approved provider and service details Name of the aged care service this report relates to: RACS ID: Name of the approved provider this report relates to: Unexplained Absence details Has the unexplained absence of the care recipient been reported to the police? Yes provide details below No go to question 12 Date reported to police Time reported to police Police station reported to (if applicable) Incident number Has the care recipient returned to the service? Yes provide details below No report unexplained absence to police Date returned Time returned In relation to the circumstances resulting in the unexplained absence of this care recipient, what action has been taken to manage or minimise the risk of the unexplained absence occurring again? If the care recipient is still missing from the service, what action is being taken to locate the care recipient? Statement I declare that the information I have provided in this form is complete and correct. Your Name Date