IN THE COURT OF CHANCERY OF THE STATE OF DELAWARE IN THE MATTER OF: , A p erson with an alleged disability : : : : C.M. # PRELIMINARY ORDER FOR THE APPOINTMENT OF AN ATTORNEY AD LITEM AND TO SCHEDULE THE HEARING AND NOW, the Petition for the Appointment of a Guardian of (check all that applies): the p erson and/or the p roperty of , a person with an alleged disability ( person with an alleged disability ) filed in this matter having been read and duly considered by the Court, NOW , THEREFORE, IT IS ORDERED this day of , 20, as follows: 1. A hearing shall be held at the Court of Chancery in County, Delaware on , 20, at 9:30 a.m. to determine if the proposed guardian (s) should be appointed the guardian(s) of the person and/or property of the person with an alleged disability . 2. , Esquire, is appointed attorney ad litem for the person with an alleged disability . 3. The attorney ad litem shall give actual notice of the petition to the Rev. 4/2018 American LegalNet, Inc. www.FormsWorkFlow.com person with alleged disability pursuant to Chancery Court Rule 176 . The attorney ad litem shall visit the person with an alleged disability at his or her residence. If such a vis it is not possible, the attorney ad litem shall detail why the visit was not possible in his or her report. 4. The attorney ad litem shall file a report with the Court before noon on this date: . 5. Pursuant to the 4 of this Order: a. All physicians, hospitals, and other healthcare providers covered under the Privacy Standards of the Health Insurance Portability and Accountability Act (HIPAA) are authorized to disclos e 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 person with an alleged disability [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 shall grant said access describ 5 ad litem without delay . American LegalNet, Inc. www.FormsWorkFlow.com c. The attorney ad litem is prohibited from using or disclosing the health information of the person with an alleged disability 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 physicia n(s), hospital(s), or healthcare provider(s) (including all copies made) at the end of these guardianship proceedings. 6. At least thirteen (1 3 ) days before the hearing date, the p etitioner(s) must send a copy of this p reliminary o rder and notice by certified mail, return receipt requested, to each interested party who did not sign a Waiver of Notice and Consent. The notice must state the time, place and purpose of the hearing. 7. certified receipts from the notice(s) mailed to the interested parties no later than two (2) days before the hearing date. Chancellor/Vice Chancellor/Master American LegalNet, Inc. www.FormsWorkFlow.com