JDF 850SC R6/19 GUARDIAN222S REPORT - ADULT Page 1 of 7 District Court Denver Probate Court County, Colorado Court Address: In the Interest of: Ward COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom GUARDIAN222S REPORT 226 ADULT INITIAL REPORT/CARE PLAN ANNUAL REPORT Current Reporting Period From To (MM/DD/YYYY) (MM/DD/YYYY) (REPORTING DATES MUST BE FOR THE PAST YEAR AND MAY NOT REPORT INTO THE FUTURE.) Instructions to Guardian: Colorado law requires that every guardian of an adult complete a Guardian222s Report every year. When answering the questions in this report, you are required to provide details. Answers such as 223same as last report/year224 and 223no change since last report224 are not acceptable answers. Your report may be rejected with those answers. COLORADO LAW REQUIRES THAT ANY GUARDIAN WANTING TO REMOVE THE ADULT FROM THE STATE OF COLORADO MUST OBTAIN COURT PERMISSION. You must file the necessary forms to make this request and obtain Court permission. CONTACT INFORMATION Ward222s Information: Check if Updated Information from last report (Annual Report ONLY) Check if Residency is Temporary (Care Plan ONLY) Name: Age: Sex: Street Address: (Include Name of Living Center or Nursing Home) City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary Phone: Alternate Phone: Guardian222s Information: Check if Updated Information from last report Name: Age: Occupation: Your Relationship to Ward: Street Address: American LegalNet, Inc. www.FormsWorkFlow.com JDF 850SC R6/19 GUARDIAN222S REPORT - ADULT Page 2 of 7 City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary Phone: Alternate Phone: Email Address: Have you had any criminal charges filed against you or convictions entered since the last report? Yes No If Yes, explain: Co-Guardian222s Information (if applicable): Check if updated information from last report Name: Age: Occupation: Your Relationship to Ward: Street Address: City: State: Zip Code: Mailing Address, if different: City: State: Zip Code: Primary Phone: Alternate Phone: Email Address: Have you had any criminal charges filed against you or convictions entered since the last report? Yes No If Yes, explain: I. PLACEMENT AND CARE SUPERVISION A. Who currently supervises the ward222s care and treatment on a daily basis? Name: Primary Phone: Alternate Phone: B. If the ward has moved since the last reporting period, identify the date of the move, address of residence, type of residence, and reason for the change. Date of Move Name of Facility and Address Type of Residence Reason for Change II. STATUS INFORMATION Yes No A. Do you recommend that the guardianship continue? If No, explain: B. Do you recommend any changes to the guardianship? If Yes, explain: American LegalNet, Inc. www.FormsWorkFlow.com JDF 850SC R6/19 GUARDIAN222S REPORT - ADULT Page 3 of 7 C. Do you wish to remain guardian? If No, explain: Note: If you wish to terminate this guardianship or modify by replacing the current guardian or adding a co-guardian, you must file a separate petition with the Court. III. CURRENT CONDITION OF THE WARD Please describe in detail the current mental condition of the ward: Please describe in detail the current physical condition of the ward: Please describe in detail the current social condition of the ward: IV. PERSONAL CARE AND OTHER ISSUES Yes No A. Has the ward222s physical and medical condition (illness/injuries) changed since the last report? If Yes, explain: B. Has the ward been hospitalized since the last report? If Yes, explain: C. Have there been any medical, social or psychological evaluations of the ward performed? Please explain: D. Is there a need for further medical, social or psychological evaluations of the ward? Please explain: E. Describe the medical, educational, vocational and other services provided to the ward. American LegalNet, Inc. www.FormsWorkFlow.com JDF 850SC R6/19 GUARDIAN222S REPORT - ADULT Page 4 of 7 Please describe in detail any medical services provided to the ward: Please list any medications provided to the ward: Please describe in detail any educational services provided to the ward: Please describe in detail any vocational services provided to ward: Please describe in detail any other services provided to ward: F. How often do you contact the ward222s medical provider? Daily Weekly Monthly Other: How do you contact the ward222s medical provider (phone, email, etc.)? G. Do you believe the current plan for care, treatment and/or rehabilitation is in the ward222s best interest? Yes No If No, describe what changes would be appropriate. H. The ward222s care and living situation is Very Good Good Adequate Poor I. Describe your plans for the ward222s future care, including any recommended changes. American LegalNet, Inc. www.FormsWorkFlow.com JDF 850SC R6/19 GUARDIAN222S REPORT - ADULT Page 5 of 7 V. VISITATION OF WARD Colorado law requires that a guardian maintain sufficient contact with the ward. A. How often do you visit the ward? Daily Weekly Monthly Other: B. How often do you contact the ward or the ward222s care provider? Daily Weekly Monthly Other: C. When was the last time you saw the ward in person? (date) D. Indicate how long your visits are and summarize your activities with and on behalf of the ward. E. Does the ward participate in decision-making? Yes No Briefly describe. VI. FINANCIAL MATTERS A. Are there sufficient financial resources to take care of the ward? Yes No If No, what do you believe is the best way to handle this problem? B. Do you have control of the ward222s income? Yes No If Yes, describe: C. If applicable, identify the representative payee for Social Security and other income benefits. Name: Phone Number: D. Have any fees been paid to you in your role as guardian? Yes No If Yes, describe: Complete this section only if the guardian has custody of funds. American LegalNet, Inc. www.FormsWorkFlow.com JDF 850SC R6/19 GUARDIAN222S REPORT - ADULT Page 6 of 7 E. Have any fees been paid to others for the care of the ward or his/her property? Yes No If Yes, describe and identify name of person: Please indicate whether you have possession or control of the following: Bank Account(s): Name of financial institution(s) and last four numbers of account(s): Estimated Value: Investment Account(s): Name of financial institution(s) and last four numbers of account(s): Estimated Value: Real Estate: Address: Estimated Value: Personal Property (i.e. jewelry, collectibles, vehicles205) Description: Estimated Value: Liabilities/Debts: Creditor(s): Estimated Amount: SUMMARY OF FINANCIAL ACTIVITY DURING REPORTING PER IOD Beginning balance of bank accounts (savings, checking, etc.) $ Plus money received (Social Security, SSI, pension, disability, interest, etc.) from any source on behalf of the Ward +$ Less total fees to care providers - $ Less total monies paid to the Ward, e.g. personal needs - $ Less total fees paid to guardian - $ Less any other expenses, e.g. housing, insurance, maintenance - $ Ending balance of bank accounts $ You are required to maintain supporting documentation for all receipts and all disbursements under your control during the duration of this appointment. The court or any interested persons as identified in the Order Appointing Guardian may request copies at any time. By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the original content of this form. American LegalNet, Inc. www.FormsWorkFlow.com JDF 850SC R6/19 GUARDIAN222S REPORT - ADULT Page 7 of 7 IMPORTANT THIS SECTION MUST BE COMPLETED CORRECTLY AND SIGNED OR THE REPORT MAY BE REJECTED. Colorado Law REQUIRES that the Guardian222s Report be served on the PROTECTED PERSON AND INTERESTED PERSONS pursuant to Order Appointing Guardian, including minors 12 years of age or older (247 15-14-309(4), C.R.S.). In the space below, list the names, addresses, and method of delivery for each party listed on the Order Appointing Guardian and