Stillwater Gardens Retirement Village

A lifestyle you deserve…

The Integrity Care Group

Facility name:	Stillwater Gardens Rest Home & Continuing Care
Admission date:		Unit & room number:
Given names:		Surname:
Known as:
Sex:	M F	Admitted from:
Age:
Date of birth:		Birth place:
Doctor:		Religion:
Community card no:		Expiry date:
Assessment classification:		NHI:
Next of kin 1:
Name:		Relationship:
Address:		Phone:
Next of kin 2:
Name:		Relationship:
Address:		Phone:
Enduring Power of Attorney 1:	Property Personal care
Name:		Relationship:
Address:		Phone:
Enduring Power of Attorney 2:	Property Personal care
Name:		Relationship:
Address:		Phone:
Other family contacts / comments: