District Court Denver Probate Court _________________________________County, Colorado Court Address: In the Interests of: COURT USE ONLY Case Number: Ward Division Courtroom ORDER APPOINTING TEMPORARY SUBSTITUTE GUARDIAN FOR ADULT PURSUANT TO §15-14-313, C.R.S. Upon consideration of the Petition for Appointment of Temporary Substitute Guardian for the above ward and/or hearing on ________________________ (date), The Court finds, determines and orders: 1. Venue is proper and the required notices have been given or waived. 2. A qualified person seeks appointment. 3. The current guardian is not effectively performing his/her duties and the welfare of the ward requires immediate action pursuant to §15-14-313, C.R.S. 4. The temporary substitute guardianship cannot exceed six months from appointment. 5. The Court appoints the following person as temporary substitute guardian for the ward: Name: Street Address: City: State: Zip Code: Primary Phone #: ____________________ Mailing Address, if different: E-mail Address: _____________________________ Alternate Phone #: ____________________________ 6. The temporary substitute guardian shall notify the Court within 30 days if the temporary substitute guardian's home address, email address, or phone number changes and/or of any change of address for the ward. 7. The authority and Letters of any guardian previously appointed by this Court are hereby suspended. 8. Copies of all future Court filings shall be provided to the following interested persons: Name Relationship to Ward Ward Guardian Spouse or partner in a civil union Parent Adult children JDF 846 R8/13 ORDER APPOINTING TEMPORARY SUBSTITUTE GUARDIAN FOR ADULT ©2013 Colorado Judicial Department for use in the Courts of Colorado Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 9. If an appointment is made without previous notice to the ward, the affected guardian or other interested persons, the temporary substitute guardian shall, within five days after the appointment, provide copies to them. 10. The temporary substitute guardian is authorized to access the ward's medical records and information. The temporary substitute guardian is deemed to be the ward's personal representative for all purposes relating to the ward's protected health information, as provided in HIPAA, Section 45 CFR 164.502(g)(2). 11. Letters of Guardianship shall be issued. This temporary substitute guardianship expires on _____________________ (date not to exceed six months from appointment). The temporary substitute guardian has the same powers as set forth in the previous Order Appointing Guardian, except as follows: 12. The Court further orders: Date: __________________________ ______________________________________ Judge Magistrate JDF 846 R8/13 ORDER APPOINTING TEMPORARY SUBSTITUTE GUARDIAN FOR ADULT ©2013 Colorado Judicial Department for use in the Courts of Colorado Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com