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Visitors report Guardianship Conservatorship Combined Form. This is a Colorado form and can be use in Probate Statewide.
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Tags: Visitors report Guardianship Conservatorship Combined, JDF 810, Colorado Statewide, Probate
District Court Denver Probate Court
__________________________________ County, Colorado
Court Address:
In the Interests of:
COURT USE ONLY
Respondent
Court Visitor (Name and Address):
Phone Number:
FAX Number:
Case Number:
E-mail:
Atty. Reg. #. :
Division
Courtroom
VISITOR’S REPORT
GUARDIANSHIP CONSERVATORSHIP COMBINED
I, ______________________________________ (name), submit the following report concerning the investigation
which I have conducted as the Court-appointed Visitor in this Guardianship pursuant to §15-14-305, C.R.S.
Conservatorship pursuant to §15-14-406, C.R.S.
Recommendations: The Court Visitor interviewed the Respondent in person on ____________________ (date).
Yes
G. An Attorney should be appointed to represent the Respondent.
Explain: _________________________________________________________
H. A Guardian ad Litem should be appointed for the Respondent.
Explain: _________________________________________________________
A professional evaluation or further evaluation should occur, §15-14-305(5)(f).
Explain: _________________________________________________________
J. The Respondent has been advised of their rights.
Pursuant to §15-14-305, C.R.S. and/or §15-14-406, C.R.S.
K. Significant concern(s) of the Court Visitor.
Explain:
F. Respondent has been advised of payment of fees in this proceeding.
Pursuant to §15-14-305(3)(c)& (d), C.R.S and/or §15-14-406 (3)(c) & (d), C.R.S
Explain: _________________________________________________________
E. Respondent has requested an attorney.
Pursuant to §15-14-305(3)(c), C.R.S and/or §15-14-406(3)(c), C.R.S
D. Respondent is objecting to the nominated guardian and/or conservator.
C. Respondent is objecting to the guardianship and/or conservatorship proceeding.
B. A Conservator should be appointed for the Respondent.
A. A Guardian should be appointed for the Respondent.
I.
No
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
JDF 810
1/08 VISITOR’S REPORT
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I.
Summary of Observations:
A.
Describe the activities of daily living (daily functions) that the Respondent can manage without
assistance, could manage with the assistance of supportive services or benefits, including the
use of appropriate technological assistance, and cannot manage:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
B.
Describe the financial functions that the Respondent can or cannot effectively manage:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Appendix 1. I have provided the Notice of Rights to Respondent (JDF 797) and have explained the
following rights:
to employ and consult with a lawyer at the Respondents own expense and the right to request a courtappointed lawyer.
to be present in person at any court proceeding and to see or hear all evidence bearing on Respondent’s
condition;
to present evidence;
to cross-examine witnesses, including any court-appointed visitor or physician;
to have a closed hearing on any issue;
to contest the Petition;
to object to the appointment of the proposed guardian/conservator or his/her powers or duties;
to object to the creation of the proposed guardianship/conservatorship or the scope or duration thereof;
and
to have a guardian ad litem appointed to represent his/her interests if the Court determines that a need
for such representation exists.
II.
Interview of Respondent:
A.
Date and place of interview:
_____________________________________________________________________________
_____________________________________________________________________________
B.
Other persons present:
_____________________________________________________________________________
_____________________________________________________________________________
C.
Respondent’s physical appearance:
_____________________________________________________________________________
_____________________________________________________________________________
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D.
Yes No
Was Respondent oriented as to time and place?
_____________________________________________________________________________
_____________________________________________________________________________
E.
After my explanation of the substance of the Petition, the nature, purpose, and effect of the
proceeding, and the general powers and duties of a Guardian, Conservator, or both, as
appropriate to this case, the Respondent was asked and responded as follows:
1. Do you understand that explanation?
Yes No Did Not Respond
If No, please explain or comment. ______________________________________________
__________________________________________________________________________
2. Do you understand the statement of rights (JDF 797)?
Yes No Did Not Respond
Yes No Did Not Respond
3. Do you have an attorney?
If Yes, please provide name: __________________________________________________
4. Do you want an attorney to be appointed for you?
Yes No Did Not Respond
Yes No Did Not Respond
5. Do you have a doctor?
If Yes, please provide name: __________________________________________________
6. Is your doctor the same doctor who provide the letter
attached to the Petition filed in these proceedings?
Yes No Did Not Respond
7. Who are the family members or other people who are the most helpful to you?
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
Guardianship Only
1. What help if any do you need with your daily living activities or
Did Not Respond
daily functions?
If Yes, in what areas? ________________________________________________________
__________________________________________________________________________
Yes No Did Not Respond
2. Do you know the proposed Guardian?
Proposed Guardian is ________________________________________.
3. Do you think that he or she should be appointed as your
Guardian?
Yes No Did Not Respond
4. How do you feel about the proposed Guardianship? (Scope, powers, duties and duration.)
Did Not Respond
Responded as follows: __________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
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Conservatorship Only
1. What help if any do you need with your finances?
Did Not Respond
Identify what specific areas (check writing, bill paying, etc.)? ______________________________
______________________________________________________________________________
______________________________________________________________________________
Yes No Did Not Respond
2. Do you know the proposed Conservator?
Proposed Conservator is _________________________________________________________.
3. Do you think that he or she should be appointed as
your Conservator?
Yes No Did Not Respond
4. How do you feel about the proposed Conservatorship? (Scope, powers, duties and duration.)
Did Not Respond
Responded as follows: ________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
III.
Interview of Person Seeking Appointment as Guardian:
A.
Date and place of interview:
_____________________________________________________________________________
_____________________________________________________________________________
B.
Person seeking appointment was asked and responded as follows:
1. Name and address:
__________________________________________________________________________
__________________________________________________________________________
2. Relationship (including non-family) to Respondent:
__________________________________________________________________________
__________________________________________________________________________
3. Why was this Petition initiated?
__________________________________________________________________________
__________________________________________________________________________
4. Where has the Respondent resided during the last three months?
__________________________________________________________________________
__________________________________________________________________________
a. Who, if anyone, has been caring for the Respondent during this period?
_______________________________________________________________________
_______________________________________________________________________
b. What type of care has been provided?
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None.
In Home Care.
Assisted living.
Hospital or Nursing Home
c. What type of care will be provided if you are appointed as Guardian?
None.
In Home Care.
Assisted living.
Hospital or Nursing Home
5. What changes in residence are contemplated?
None.
Private Home. Please provide name and address.
_______________________________________________________________________
_______________________________________________________________________
Other Facility. Please provide name and address.
_______________________________________________________________________
_______________________________________________________________________
IV.
Interview of Person Seeking Appointment as Conservator:
A.
Date and place of interview:
_____________________________________________________________________________
_____________________________________________________________________________
B.
Person seeking appointment was asked and responded as follows:
1. Name and address:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
2. Relationship (including non-family) to Respondent:
__________________________________________________________________________
__________________________________________________________________________
3. Why was this Petition initiated?
__________________________________________________________________________
__________________________________________________________________________
4. Where has the Respondent resided during the last three months?
__________________________________________________________________________
__________________________________________________________________________
5. Who, if anyone, has been handling the Respondent’s financial affairs during this period?
__________________________________________________________________________
__________________________________________________________________________
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6. Does the Respondent owe you any money or property?
Yes No
If Yes, please explain. ________________________________________________________
__________________________________________________________________________
Yes No
7. Do you owe the Respondent any money or property?
If Yes, please explain. ________________________________________________________
__________________________________________________________________________
V.
Interview of Other Interested Person:
A.
Name of Person: ______________________________ Relationship to Respondent: _________
B.
Date and place of interview:
_____________________________________________________________________________
_____________________________________________________________________________
C.
Other person asked and responded as follows:
1.
Address: _______________________________________________________________
2.
Occupation: ______________________________________________
3.
Should a Guardian or Conservator be appointed?
Yes No
Comments: ________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Note:
VI.
This section should be completed as many times as there are interested persons. Attach
the additional interview notes to this report.
Report on Condition of Respondent’s Present Residence:
Visited Information otherwise obtained:
A.
Date ____/____/____
B.
Address: ______________________________________________________________________
_____________________________________________________________________________
C.
Type of Abode: ________________________________________________________________
D.
Condition (if at home):
1. Lawn and Landscaping: ______________________________________________________
2. Exterior: __________________________________________________________________
3. Interior: ___________________________________________________________________
a. Utilities working Yes No Additional comments____________________________
b. Clean
Yes No
Yes No
Additional comments____________________________
Additional comments____________________________
c. Fire Hazards
d. Other (explain) _________________________________________________________
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VII.
Report on Condition of Respondent’s Proposed Residence, if applicable:
Visited Information otherwise obtained:
A.
Date ____/____/____
B.
Location and type of place:_______________________________________________________
_____________________________________________________________________________
C.
Condition: ________________________________________________________________
1. Lawn and Landscaping: ______________________________________________________
2. Exterior: __________________________________________________________________
3. Interior: ___________________________________________________________________
a. Utilities working Yes No Additional comments____________________________
b. Clean
Yes No
Yes No
Additional comments____________________________
Additional comments____________________________
c. Fire Hazards
d. Other (explain) _________________________________________________________
VIII.
Physicians or Other Persons Who Are Known to Have Treated, Advised, or
Assessed the Respondent’s Relevant Physical or Mental Condition:
Please identify the sources of the information: _____________________________________________
___________________________________________________________________________________
A.
Physicians and Psychiatrists:
_____________________________________________________________________________
_____________________________________________________________________________
B.
Psychologists and Psychotherapists:
_____________________________________________________________________________
_____________________________________________________________________________
C.
Nurses and Nurse Aids:
_____________________________________________________________________________
_____________________________________________________________________________
D.
Other Compensated Health Care Providers:
_____________________________________________________________________________
_____________________________________________________________________________
E.
Family Members, Relatives, and Friends:
_____________________________________________________________________________
_____________________________________________________________________________
F.
Others:
_____________________________________________________________________________
_____________________________________________________________________________
The Court Visitor represents that there is no conflict of interest between the Court Visitor and any party.
Date: ______________________
JDF 810
1/08 VISITOR’S REPORT
___________________________________________
Signature of Court Visitor
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