JDF 829 SC R 9/18 ORDER APPOINTING EMERGENCY GUARDIAN FOR MINOR Page 1 of 2 District Court Denver Probate Court County, Colorado Court Address: In the Interests of: Minor COURT USE ONLY Case Number: Division Courtroom ORDER APPOINTING EMERGENCY GUARDIAN FOR MINOR P URSUANT TO 247 15 - 14 - 204(5), C.R.S. Upon consideration of the Petition for Appointment of Emergency Guardian for the above minor and hearing on (date) , The c ourt finds , determines and orders : 1. V enue is proper . 2. Notice pursuant t o 247 15 - 14 - 204(5), C.R.S. was: Reasonable . Dispensed with because the c ourt finds from affidavit or testimony that the m inor will be substantially harmed before a hearing can be held on the p etition. A. If the emergency guardian is appointed without notice, notice of the appointment m ust be given within 48 hours after the appointment to the following: Name Relationship to Minor Minor if 12 years or older at time of mailing Parent Parent Person with care or custody if other than parent B. A hearing on the appropriateness of the appointment must be held within five days after the appointment. The hearing will be held at the following time and location: Date: Time: Courtroom or Division: Address: 3. The minor was born on (date). 4. Following the procedures in 247 15 - 14 - 201 , et seq . is likely to result in s ubstantial harm to the m health or safety and no other person appears to have a uthority to act in the circumstances pursuant to 247 15 - 14 - 204(5) , C.R.S. 5. The emergency guardianship cannot exceed 60 days from appointment . American LegalNet, Inc. www.FormsWorkFlow.com JDF 829 SC R 9/18 ORDER APPOINTING EMERGENCY GUARDIAN FOR MINOR Page 2 of 2 6. The c ourt appoints the following person as emergency g uardian for the m inor: Name: Street a ddress: C ity: State: Zip Code: Mailing a ddress, if different : City: State: Zip Code: Primary phone: Alternate phone: Email a ddress: 7. Letters of guardianship will be issued . This emergency guardianship expires on (date not to exceed 60 days from appointment.) The powers and duties of the emergency guardian are as follows: To perform any and all acts necessary for the day - to - day care, custody, educa tion, recreation, and property of the minor . T o access m e mergency g uardian is deemed to be the m the m provided in HIPAA, Section 45 CFR 164.502(g)(2). To authorize any and all medical and dental care for the health and well - being of the m inor . This care includes, but is not limited to , medical and dental exams and tests, x - rays, surgeries, anesthesia , and hospita l care. To authorize mental health treatment , subject to 247 27 - 65 - 107, C.R.S . Other: 8. The c ourt further orders: Date: Judge Magistrate American LegalNet, Inc. www.FormsWorkFlow.com