IN THE COURT OF CHANCERY OF THE STATE OF DELAWARE IN AND FOR Please select a county In the Matter of: C.M.# AN ALLEGED DISABLED PERSON PRELIMINARY ORDER AND NOW, TO WIT, on this date , the Petition for the Appointment of a Guardian of (check all that applies): the Person and/or the Property of hereinafter called "alleged disabled person", filed in this alleged disabled person's name matter having been read and duly considered by the Court, NOW, THEREFORE, IT IS ORDERED THAT: 1. A Hearing shall be held at the Court of Chancery in Please select a county county in which the case will be determined County, Delaware on Friday, , 20 leave blank at 9:30 a.m. to leave blank determine if the Petitioner should be appointed the Guardian of the Person and/or Property of the alleged disabled person. 2. , Esquire is appointed attorney ad litem for leave blank the alleged disabled person. American LegalNet, Inc. www.FormsWorkflow.com 3. The Court shall issue notice to the attorney ad litem for the alleged disabled person at least ten (10) days before the Hearing date pursuant to Chancery Court Rule 176(c) unless the appointed attorney ad litem files a Waiver of Service upon notification of the appointment. 4. The attorney ad litem shall give actual notice of the Petition to the alleged disabled person pursuant to Chancery Court Rule 176(a) unless the Physician's Affidavit says it would be detrimental or meaningless to give notice. 5. The attorney ad litem shall file a report with the Court before noon on this date . leave blank 6. Pursuant to the preparation of the report referenced in paragraph “5” of this Order: a. All physicians, hospitals and other healthcare providers covered under the Privacy Standards of the Health Insurance Portability and Accountability Act (HIPPA) are authorized to disclose to the attorney ad litem and shall provide the attorney ad litem unobstructed access to all medical records, treatment providers, clinical information and other healthcare information relating to the current mental and physical health of the Disabled Person [See 45 CFR sec.164.512(e)] that the attorney ad litem deems necessary for the proper discharge of his/her duties. b. All said physicians, hospitals and other healthcare providers grant said access described in paragraph “6a” of this Order to the attorney ad litem without delay; American LegalNet, Inc. www.FormsWorkflow.com c. The attorney ad litem and the said physicians, hospitals and other healthcare providers are prohibited from using or disclosing the disabled person's health information for any purpose other than this Guardianship proceeding. d. The attorney ad litem shall return to the physician(s), hospital(s), and other healthcare provider(s) or shall destroy all of the health information provided to the attorney ad litem by the physician(s), hospital(s), or healthcare provider(s) (including all copies made) at the end of these Guardianship proceedings. 7. At least ten (10) days before the Hearing date, Petitioner must send notice by certified mail, return receipt requested, to each next of kin of the alleged disabled person who did not file a Waiver of Notice and Consent. Notice must state the time, place and purpose of the Hearing. 8. Petitioner must file at the Register in Chancery Office all certified receipts from the notice(s) mailed to the next of kin no later than the Wednesday before the Hearing date. (Vice) Chancellor or Master American LegalNet, Inc. www.FormsWorkflow.com