SUPERIOR COURT INVESTIGATORS SUPERIOR COURT OF SAN JOAQUIN COUNTY In The Conservatorship of: REPORT TO THE COURT ON THE STATUS OF CONSERVATEE CASE NUMBER I, am the Conservator of the above-named Conservatee and my status report is as follows: 1. Present age of the Conservatee: Conservatee222s Date of birth: 2.Current Living arrangements of the Conservatee:A.Name of care facility/board and care: B.Current address: C.Phone number of Conservatee: D.The Conservatee222s residence is own home/apartment Conservator222s home/apartment nursing home hospital or medical facility boarding home relative222s home (relationship) other (specify) E.The Conservatee has been in the present residence since (date):. If moved within the past year,state reason(s) for change: F.I rate the Conservatee living arrangement as Excellent Average Below average (Explain) G.I believe the Conservatee is: content with the living situation unhappy with the living situation H.I recommend a more suitable living arrangement for the adult as follows: 3.Physical HealthA.I believe that the Conservatee222s current physical condition is Excellent Good Fair Poor B.During the past year the Conservatee222s physical condition has: remained about the same improved (Explain) worsened (Explain) C.During the past year the Conservatee received the following medical treatment; (Include check-ups and dental):Date Ailment Type of Treatment Doctor222s Name STATUS REPORT ON CONSERVATEE CONFIDENTIAL American LegalNet, Inc. www.FormsWorkFlow.com CI-12 (01/11) STATUS REPORT ON CONSERVATEE CONFIDENTIAL 4.Mental HealthA.I believe the Conservatee222s current mental condition is Excellent Good Fair Poor B.During the past year the Conservatee222s mental condition has: remained about the same. improved (Explain) worsened (Explain) C.During the past year, treatment or evaluation by a psychologist or social worker: was provided was not provided D.IF conservatee is a client of Valley Mountain Regional Center please provide:(Case Manager Name): (Phone Number): 5.Social Activities/ServicesA.The conservatee222s social condition is Excellent Good Fair Poor B.During the past year, the Conservatee222s social condition has: remained about the same improved (Explain) C.IF conservatee participates in a day-program please provideName of Program: Address: Phone Number: D.During the past year, the Conservatee has participated in the following activities: Recreational Educational Social Occupational Other organizations/programs the Conservatee participates in; describe: If the conservatee does not attend a day-program, please explain why: 6.List of Visits Please check this box if the conservatee lives with the conservator. A.The last visit to the conservatee was on . During the past year, I visited the Conservatee asfollows: B.The average amount of time I spent on each visit was: 7.I intend to change or I request the court to be able to change the following:A.The Conservatee222s living arrangement (describe);B.The current financial management of estate including the sale of any assets (describe); 8.The conservatorship should be should not be continued because:9.A. I am the Conservator of the Person Only for the Conservatee.B.I am the Conservator of the Person and Estate and my accounting will be filed separately. Address: Check if (Signature) new address Phone: Check if (Date)new phone # American LegalNet, Inc. www.FormsWorkFlow.com