Resolute Care – Associate Provider Onboarding

Business Details

Legal Entity Name *

ABN *

Registered Business Address *

Primary Contact Person *

Position / Role *

Email Address *

Phone Number *

Emergency Contact Name *

Emergency Contact Phone *

Website (if applicable)

Preferred Communication Method *

Billing Contact Email

Billing Contact Phone

Insurance & Compliance

Required minimums: Public Liability $10M · Professional Indemnity $5M–$10M · Workers Compensation as required by law · Medical Malpractice if delivering clinical care.

Public Liability Insurance Amount *

Professional Indemnity Amount *

Workers Compensation Policy Number

Workers Compensation Expiry Date

Document Uploads

Certificates of Currency (Public Liability & Professional Indemnity) *

📎

Click to upload or drag and drop

Upload both PL and PI certificates together · PDF, JPG or PNG · Max 25MB each

Business Registration *

📄

Click to upload or drag and drop

ASIC extract or ABN registration

Service Menu / Price List *

💲

Click to upload or drag and drop

PDF, Word or Excel

Clinical Documentation (AHPRA Registration & Governance Framework)

🏥

Click to upload or drag and drop

Upload both AHPRA registration and Governance Framework together (if applicable)

Worker Screening Check / Police Check / Employee Register *

🪪

Click to upload or drag and drop

Upload Worker Screening Checks, Police Checks and/or your Employee Register here — you can add multiple files · PDF, JPG, PNG, Word or Excel · Max 25MB each

Compliance History

Any serious incidents in the past 3 years? *

Any complaints upheld in the past 3 years? *

If yes to either above, please provide details

Professional references / referee details (if requested)

Policies & Governance Documents

Required policy uploads for approval

Complaints & Incident Management Policies *

📋

Click to upload or drag and drop

Upload both policies as separate files · PDF or Word

Privacy & Confidentiality Policy *

🔒

Click to upload or drag and drop

PDF or Word document

Safeguarding / Abuse Prevention Policy *

🛡️

Click to upload or drag and drop

PDF or Word document

Open Disclosure Policy (if applicable)

📣

Click to upload or drag and drop

PDF or Word document

Declaration & Acknowledgements

By submitting this application, the authorised representative confirms and acknowledges the following on behalf of the provider:

I acknowledge the Aged Care Code of Conduct and agree to comply with it in the delivery of all services. I acknowledge the Statement of Rights and confirm all staff are trained to uphold consumer rights including dignity, choice, privacy and supported decision making. I confirm our organisation has a documented incident management process that meets mandatory reporting requirements and immediate escalation obligations. I understand that all services will only commence after contract execution with Resolute Care Group. I confirm our workers will only work within their approved scope as outlined in the Associate Provider Agreement. I understand there are subcontracting restrictions and we will not subcontract services without prior written approval from RCG. I agree to open disclosure obligations and will report risks/incidents to RCG immediately. All information provided in this application is true and accurate to the best of my knowledge.

Authorised Representative Full Name *

Position / Title *

Signature Date *

Digital Signature (type full name) *

Application Submitted

Thank you for applying to become an Associate Provider with Resolute Care Group. Our team will review your submission and contact your nominated primary contact within 5–10 business days.

Reference:

Associate Provider Onboarding

Business Details

Insurance & Compliance

Workforce Compliance

Services & Capability

Policies & Governance Documents

Declaration & Acknowledgements

Application Submitted