SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION _________ _________ INT IDD _________ _________ In re ________________________________ An Adult ORDER_APPOINTING COUNSEL, EXAMINER, VISITOR, AND/OR GUARDIAN AD LITEM Upon consideration of the petition filed herein on the ______ day of ____________, 20______, it is hereby by the Court this ____ day of ____________________, 20______, [ ] ORDERED that a hearing will be held on__________________, 20______, at __________ o'clock a.m./p.m. in Courtroom _____ of the Superior Court of the District of Columbia, Building A, 515 5th Street, NW, Washington, DC, before Judge ______________________________ and it is further [ ] ORDERED a Criminal Background Statement must be filed by the person seeking appointment as guardian before the hearing scheduled above. [ ] ORDERED that the following persons are appointed and shall attend unless excused [ ] Counsel: _____________________________ is appointed counsel for by the Court: _________________________________, the subject of the above proceeding. The counsel shall have access to any current medical, psychological, or sociological evaluation records of the subject. Counsel shall perform the duties set forth in D.C. Code, sec. 21-2033(b) and the duties set forth in Superior Court, Probate Division Rule 305 that are consistent with this statutory provision and shall represent the subject at the hearing. Counsel shall forthwith file a Notice of Appearance pursuant to Superior Court, Probate Division Rules 321(d) and 305(a)(2). [ ] Examiner: The request for appointment of an examiner is denied because _________________________________________________________________________ _________________________________________________________________________ [ ] Examiner: ______________________________________ is appointed examiner and shall have access to any current medical, psychological, or sociological 1 November 2015 ­ 958.10.v3 American LegalNet, Inc. www.FormsWorkFlow.com evaluation records of the subject. The examiner shall perform the duties set forth in D.C. Code, sec. 21-2041(d) and/or sec. 21-2054(a) as applicable and Superior Court, Probate Division Rule 326 and submit a report in writing to the Court and mail copies to all persons listed below at least ten (10) days before the hearing. [ ] Visitor: ______________________________________ is appointed visitor and shall perform the duties set forth in D.C. Code, sec. 21-2033(c) and Superior Court, Probate Division Rule 327 and submit a report in writing to the court and mail copies to all persons listed below at least ten (10) days before the hearing. [ ] Guardian ad litem: Pursuant to D.C. Code, sec. 21-2033(a) and the provisions of Superior Court, Probate Division Rule 306 that are consistent with this statutory provision, a guardian ad litem is appropriate for the following reasons: ___________________________________________________________________________ ___________________________________________________________________________ _____________________________________________________________________, so ________________________________________ is appointed guardian ad litem herein and shall have access to any current medical, psychological, or sociological evaluation records of the subject for the following purpose(s): [ ] To assist the subject to determine his or her best interests in regard to this proceeding; or [ ] To make the determination of the subject's best interests in regard to this proceeding if the subject is unconscious or otherwise wholly incapable of determining his/her interests even with assistance; or [ ] To prosecute or defend the best interests of ______________ because the Court has determined for reasons stated below that representation would otherwise be inadequate. The guardian ad litem shall not serve as an independent finder of fact, investigator, ombudsman, or other neutral party and shall have the following specific duties in addition to those set forth above: _________________________________________________________ ___________________________________________________________________________ _______________________________________ JUDGE cc: 2 November 2015 ­ 958.10.v3 American LegalNet, Inc. www.FormsWorkFlow.com