CONNECTICUT Conservator222s Report PC-371 REV1/1 Conservator222s Report PC - 371 Page 1 of 2 RECEIVED: Instructions: condition of the person under conservatorship. If there is no conservator of the person appointed, the conservator of the estate may use this form to file a report with the court one year after a conservator was appointed and every three years after the initial appointment as part of the statutory review of the conservatorship. ) Upon termination of a temporary conservatorship, the temporary conservator may also use this form to 3) 4) Type or print the form in ink. Probate Court Name District Number In the Matter of Hereinafter referred to as the person under conservatorship Present Address of the Person under Conservatorship Conservator (Nameddress) Present Treating Physician (Name and address This conservator222s report is being filed for the following reason: Annual Report Significant change in person under conservatorship222s capacity Court-ordered Report to meet essential requirements for health or safety Statutory Conservatorship Review Temporary Conservatorship terminated Please respond to the following questions for the period since the last conservator222s report was filed in court, or if this is the first report, since your appointment as conservator. 1.Indicate the number of your visits with the person under conservatorship: 2.Describe the changes, if any, to the mental, emotional or physical condition of the person under conservatorship. 3. Describe any significa nt actions you have taken regarding the person under conservatorship , if applicable. 2) American LegalNet, Inc. www.FormsWorkFlow.com CONNECTICUT PROBATE COURTS Conservator222s Report PC-371 REV 1/1 Conservator222s Report PC - 371 Page 2 of 2 4. List any significant problems that have arisen relating to the conservatorship, if applicable. 5. State whether the appointment of a conservator continues to be the least restrictive means of intervention for managing the needs of the person under conservatorship. If not, state what other means may be available. 6. Describe the efforts you have made to encourage the independence of the person under conservato rship. Please complete this section if the report is completed in connection with a statutory review of the conservatorship. In my opinion, the conservatorship should be continued modified terminated. State reason for your answer: Signature of Conservator Type or Print Name Date American LegalNet, Inc. www.FormsWorkFlow.com