Residential care notification

About this form

Residential care providers should complete this form when one of our clients is in long-term care and there's been a change in their situation.

You need to tell us within 24 hours after the change happens.

You don't need to tell us when the:

client is in respite care
client's level of care has changed within the same rest home/hospital
client is in short-term public hospital care.

Please note the questions in this form may change dynamically based on your answers to previous questions.

Keeping a copy of this form

After you submit the form, you’ll see a confirmation page with all the info you entered. If you want to keep a copy, you can print that page or save it as a PDF using the browser’s print function.

Care provider's details

Provider name (required)

Address Line 1 (required)

Address Line 2 (optional)

Suburb (optional)

City (required)

Postcode (required)If you're not sure what the postcode is for this address, you can find it with the NZ Post postcode finder

Phone number (required)This must be a valid New Zealand number.

Email address (required)

Contact person's name (required)