Annual Report Of The Guardian Of The Person

CAUSE NO. _________________ IN RE: GUARDIANSHIP OF THE PERSON OF [WARD'S NAME] § § § § § IN THE PROBATE COURT OF DENTON COUNTY, TEXAS Please note that this document needs to be completed as fully and descriptively as possible. It will be returned to you if it is not completed according to the requirements mandated by the Texas Probate Code. ANNUAL REPORT OF THE GUARDIAN OF THE PERSON Now comes ______________________(GUARDIAN), Guardian of __________________________, Ward in the above entitled and numbered cause, and present herewith a report covering the time period of ____________________(Month/Day),20___ through _________________(Month/Day), 20___, on the Ward’s physical well-being, location, and condition pursuant to Section 743(b) of the Texas Probate Code. GENERAL INFORMATION 1. Ward’s Age:______ Date of Birth:________________________________ 2. Ward’s present address & phone:_________________________ ____________________________________________________________________ 3. The type of home in which the Ward resides can be described as: ___________________________________________________________________ (the Ward’s own, a nursing/foster home, guardian’s home, relative’s home, and the Ward’s relationship to the relative; a hospital/medical facility, or other type of residence.) 4. Guardians present address & phone:________________________ ___________________________________________________________________ 5. Has the Ward’s residence changed in the last twelve (12) months? If so, state the date and reasons for such change._________________________________________________________ __________________________________________________________________ Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com 6. The Ward’s present living conditions are: ______ above average ______ good ______ in need of improvement Please Describe. When improvement is needed, briefly describe all problems and your plan to seek improvement: ____________________________________________________________________ ____________________________________________________________________ 7. Does the Guardian believe the Ward is content or unhappy with his/her living arrangements? Please explain: __________________________________________________________________ __________________________________________________________________ INDIVIDUAL CASE STATUS INFORMATION 1. The day to day care presently provided to the Ward is: _____above average _____good _____ in need of improvement Please Describe. When improvement is needed, briefly describe the problems and your plan to improve care: _________________________________________________________________ _________________________________________________________________ 2. The Ward’s present physician and physician’s address is: __________________________________________________________________ ___________________________________________________________________ Is the Ward presently receiving medical care for a physical or mental condition? If so, briefly describe the condition and give the name and address of the care provider if it is not the Ward’s physician. (i.e. psychiatrist, social worker, case manager, dentist,etc.) ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 3. 4. The Ward’s physical and /or mental condition over the last twelve (12) months has: _____improved _____ remained unchanged _____ deteriorated Please describe any change in detail. If the Ward’s condition has deteriorated, please attach a letter from Ward’s treating physician briefly describing the Ward’s condition and whether any improvement can be expected. Please list the number of times during the last reporting period that you have applied for emergency detention of the Ward. _______________________________ Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com 5. As the Guardian, give your evaluation of the Ward’s unmet needs. __________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 6. If this Guardianship should be continued, then state reasons: ___________________________________________________________________ ___________________________________________________________________ 7. Should the Guardians power be increased, decreased, or unaltered? Explain change, if recommended. _______________ ___________________________________________________________________ ___________________________________________________________________ 8. Pursuant to the standing requirements of the Court with respect to quarterly visitation of the Ward by the Guardian; has the Guardian visited the Ward during the last twelve(12) months? _____ Yes _____ No _____ Ward lives with Guardian If yes, list the number of visitations and the dates. If no, explain why. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 9. Are you the Guardian of the Ward’s estate? _____ Yes _____ No 9.a. If yes, have you filed the annual accounting with this Court? _____ Yes on __________________, 20______. (Date.) If Yes, Please go to Question #11. _____ No If no, please answer all items on Question #10. 10. If, during the last twelve (12) months, the Guardians have received and/or spent funds for the care and maintenance of the Ward, provide the amounts below. State all funds received from any source. a) b) Total funds received: $ _________ year Source: / month SSI = $ __________________________________________ SSDI = $ _________________________________________ VA = $ ___________________________________________ Social Security Survivor Benefits= $ _____________ Trust account allowance = $ ______________________ Other = $ ________________________________________ Page 3 of 6 American LegalNet, Inc. www.FormsWorkFlow.com c) Total funds spent for Ward’s care: $____________ /year d) In what type of account are the funds maintained? (Circle one) 1) Separate designated account 2) Joint account with Ward 3) Other (please list) ___________________. e) Does the Guardian use personal funds to provide support to the Ward not otherwise provided? Yes, Amount = _________________ OR No 11. The Ward’s present physical and/or mental condition is: _____ above average _____ good _____ in need of improvement Please describe any change in detail. When improvement is needed, briefly describe all problems and your plan to seek improvement: __________________________________________ ___________________________________________________________________ ___________________________________________________________________ 12. Briefly describe all social activities in which the Ward has participated during the last twelve (12) months: __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 13. Has the guardian paid the corporate bond premium for the next reporting period? Yes / No 14. Please □ □ □ □ □ □ □ □ list your relationship to the Ward: Attorney Guardianship program volunteer Uncompensated family members/friend Corporate fiduciary Private Professional Guardian Department of Aging and Disability Services Guardianship Program Other ______________________ 15. Are you a compensated Guardian? Yes / No Page 4 of 6 American LegalNet, Inc. www.FormsWorkFlow.com 16. Are you exempt from qualification under the Guardianship Certification requirements under Government Code Chapter 111? (Attorney, guardianship program volunteer, uncompensated family members and friend, or corporate fiduciary) Yes / No 17. If not exempt, please list certification number: _______________________________________________________ (Private Professional Guardian, Department of Aging and Disability Services, Guardianship Program Staff) Please use this space to provide any other relevant information that would aide the Court in determining continuation of this Guardianship. Page 5 of 6 American LegalNet, Inc. www.FormsWorkFlow.com OATH OF GUARDIAN (This report must be sworn before an officer authorized to administer oaths before it will be accepted for filing.) THE STATE OF TEXAS COUNTY OF ____________ § § § BEFORE ME, the undersigned authority, on this the _____ day of ____________, 20___, who duly sworn, states that the within and foregoing report is true, correct, and a complete statement of the present location, condition, and well-being of _________WARD___________, an Incapacitated Person, as of the date stated herein. Guardian (signature)__________________ Printed Name:_________________________ Current Address:______________________ County, State, Zip:___________________ SWORN TO AND SUBSCRIBED BEFORE ME, on this the _____ day of _____________, 20___. (Seal) ___________________________________________ Notary Public in and for the State of Texas Page 6 of 6 American LegalNet, Inc. www.FormsWorkFlow.com