Probate Rules 16(e)(1)(A), 16(e)(3) & 17(e) Page 1 of 12 PG-205 ()(cs) AS 13.26., 13.26.50 & 13.06.100 GUARDIANSHIP IMPLEMENTATION REPORT & INVENTORY IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Protective Proceedings of: ) )Name of Ward: ) )Date of Birth: ) )Residential location of ward: ) ) ) CASE NO. Ward222s Telephone #: ) ) GUARDIANSHIP )IMPLEMENTATION REPORT AND INVENTORY Instructions Please type or print clearly using black ink. In preparing the report, you must consult with the ward as much as possible. The court will treat the information in this report as confidential. If you are unable to complete this form without help, you may find assistance on the website of the Office of Public Advocacy (OPA): www./. Your local library and court may also have a binder of helpful information entitled 223Family Guardian Education Materials,224 prepared by the Alaska State Association for Guardianship and Advocacy. You may also call OPA at 269-3500 (in Anchorage), 451-5933 (in Fairbanks) or 1-877-957-3500. After completing this report, you must sign it under oath (or affirmation) in the presence of a notary public or court clerk. See last page. If you are a full guardian with the powers of a conservator, you must fill out the entire form. If you are a partial guardian and do not have the powers of a conservator (or if a separate conservator has been appointed), you do not need to fill out the financial information in paragraphs 10 through 15. The purpose of this report is to give the court as complete a picture as possible of the ward222s current situation and what you are going to do to implement the guardianship plan. Information About Guardian Guardian222s Name Daytime Phone Mailing Address (box or street number) (city) (state) (ZIP) Check here if this mailing address is new. If you change your address, please notify the court. Residence Address (street address) (city) (state) Do you live with the ward? Yes No Relationship to ward: American LegalNet, Inc. www.FormsWorkFlow.com In what areas do you have the authority to make decisions for the ward? housing medical care school & job training employment social & recreational activities financial management (you control ward222s finances because you have conservator powers) Has a separate conservator been appointed for the ward? No Yes Name: If you are a private guardian charging fees, is there a court order authorizing payment of fees and establishing an hourly rate and maximum monthly amount as required by Probate Rule 16 and AS 08.26.110? Yes No I do not charge fees. Information About Ward 1.Housing.a.On the date you were appointed guardian, where did the ward live?Name of facility or place: Address: (street address)(city) (state) (ZIP)Type of Residence: nursing home assisted living home b.Where does the ward live now? In the same place described above. In a different place. Describe: c.If the ward lives in your home, do you charge the ward rent? Yes No If you live in the ward222s home, are you paying rent? Yes No d.Have you discussed the ward222s housing arrangement with the ward? Yes. Explain what the ward wants: No, because e.Do you plan to change the place where the ward lives? No Yes, to Explain why: f.If ward lives in a nursing home, assisted living home, group home or other facility,(1) Is this the least restrictive setting in which services can be provided to theward? Yes No (2) Have you participated in developing the facility222s care plan for the ward? Yes No. (3) Do you believe the facility222s care plan is a good one for the ward (in theward222s best interests)? Yes No Explain: Probate Rules 16(e)(1)(A), 16(e)(3) & 17(e) Page 2 of 12 PG-205 ()(cs) GUARDIANSHIP IMPLEMENTATION REPORT & INVENTORY American LegalNet, Inc. www.FormsWorkFlow.com Probate Rules 16(e)(1)(A), 16(e)(3) & 17(e) Page 3 of 12 PG-205 ()(cs) A GUARDIANSHIP IMPLEMENTATION REPORT & INVENTORY g.Are there any problems with providing meals, clothing, house cleaning ortransportation for the ward? 2.Medical Care for the Ward.a.Ward222s last physical exam. Date: Doctor: Recommended treatment: I do not know when the ward last had a physical examination. I believe a physical exam is not necessary at this time. I will schedule a physical exam as follows (state when and where): b.If yes, state when and where planned: No No Does the ward require:Dental evaluation?YesEye examination? YesHearing evaluation? Yes No c.Describe any other medical problems (physical or mental) the ward has, anddescribe what is being done or will be done about them: d.Describe any plans you have to change the care currently being provided for theward222s medical problems: e.Have you discussed these medical issues with the ward? Yes. Explain what the ward wants: No. Explain why not: f.Are there any problems providing medical care or treatment for the ward? American LegalNet, Inc. www.FormsWorkFlow.com Probate Rules 16(e)(1)(A), 16(e)(3) & 17(e) Page 4 of 12 PG-205 ()(cs) GUARDIANSHIP IMPLEMENTATION REPORT & INVENTORY g.Is a no-code (Do Not Resuscitate) provision in place for the ward? Yes No h.Did the ward, while the ward still had the capacity to do so, execute a durablepower of attorney for health care or some other advance health care directiveunder AS 13.52.010 - .395 or another law? Yes No. If yes, who is theagent authorized to make health care decisions for the ward? 3.School and Job Training.a.Does the ward attend school or any type of job training? Yes. Describe studies (include name and location of school): No, because: b.Is there any type of education or training that would benefit the ward? c.Have you discussed this with the ward? Yes. Explain what the ward wants: No. Explain why not: 4.Work.a.Is the ward employed? No, because: Yes. Describe (include type of work, name of employer, address, phone, and how long employed): b.If not employed, would it be in the ward222s best interests to obtain employment? c.Have you discussed this with the ward? Yes. Explain what the ward wants: No. Explain why not: 5.Social and Recreational Activities.a.Describe activities the ward enjoys: American LegalNet, Inc. www.FormsWorkFlow.com Probate Rules 16(e)(1)(A), 16(e)(3) & 17(e) Page 5 of 12 PG-205 ()(cs) GUARDIANSHIP IMPLEMENTATION REPORT & INVENTORY b.Have you been able to help make these activities available to the ward? c.Do you have any plans concerning additional social and recreational activities forthe ward? 6.Dependents. (List anyone the ward is legally required to support.)Name Relationship to Ward Date of Birth (if under 18) 7.Contacts. a.How often have you visited the ward since you were appointed guardian? b.Have there been any other contacts? No Yes, as follows: Type of Contact How Often by telephone by mail or e-mail through 3rd person: other: 8.Decision Making. When a decision has to be made about something for the ward (housing, medical care,education, employment, recreation, purchases, etc.), how are the decisions made? a.Describe decisions made by ward alone: b.Describe decisions made by guardian alone: c.Describe decisions made by guardian and ward together: American LegalNet, Inc. www.FormsWorkFlow.com Probate Rules 16(e)(1)(A), 16(e)(3) & 17(e) Page 6 of 12PG-205 (/)(cs) AS 13.26.117, 13.26.250 & 13.06.100 GUARDIANSHIP IMPLEMENTATION REPORT & INVENTORY 9.Community Resources (service providers, churches, government programs, charitableorganizations, etc.). a.List the community organizations that are currently involved with the ward. Name of Organization Services Received Agency Phone b.List other organizations you have contacted that might be able to help the ward.Name of Organization Potential Services Agency Phone You only have to fill out paragraphs 10 - 15 if you are a full guardian with authority to manage the ward222s finances. If you do not have financial management authority, skip to paragraph 16. 10.Ward222s Current Monthly Income. (List only the income of the ward. Do not list any ofyour own income. Divide any yearly amounts by 12. Divide quarterly amounts by 3.) Income Source Monthly Amount Social Security Benefits:a. SSA b.SSI Adult Public Assistance: Veterans Financial Benefits: Alaska Longevity Bo