JDF 84 9 SC R 9/18 L ETTERS OF GUARDIANSHIP ADULT District Court Denver Probate Court County, Colorado Court Address: In the Interest of: Respondent/ Ward COURT USE ONLY Case Number: Division Courtroom LETTER S OF GUAR DIANSHIP ADULT ( g uardian) was appointed by c ourt o rder on (date) as : Guardian pursuant to 247 15 - 14 - 311, C.R.S. Emergency Guardian pursuant to 247 15 - 14 - 312(1), C.R.S. These letters will expire on ( a date not to exceed 60 days from the date of appointm ent). T he g o rder . Temporary Substitute Guardian pursuant to 247 15 - 14 - 313, C.R.S. These letters will expire on ( a date not to exceed 6 months from the date of appointment). T he g pecified in the previous O rder of A ppointment . The g uardian must have access to r w the r espondent/ w ard is entitled. The g uardian must be deemed to be the r / w al representative for all purposes relating to his or her protected health information, as provided in HIPAA, Section 45 CFR 164.502(g)(2) . Th ese Letter s of Guardianship are proof of the g ull authority to act , except for the f ollowing restrict ions: The g uardian does not have the authority to obtain hospital or institutional care and treatment for mental illness, developmental disability , or alcoholism against the will of the r espondent / w ard pursuant to 247 15 - 14 - 316(4), C.R.S. T he r espondent / w ard must not be changed from the State of Colorado without an order of the c ourt pursuant to 247 15 - 14 - 315(1)(b), C.R.S. Other limitations : Date: Probate Registrar / ( Deputy ) Clerk of Court CERTIFICATION Certified to be a true copy of the original in my custody and to be in full fo rce and effect as of (date). Probate Registrar/(Deputy)Clerk of Court American LegalNet, Inc. www.FormsWorkFlow.com