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Plan Of Conservator Of Person Form. This is a District Of Columbia form and can be use in Superior Court Statewide.
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Tags: Plan Of Conservator Of Person, District Of Columbia Statewide, Superior Court
SUPERIOR COURT OF THE DISTRICT OF COLUMBIA
PROBATE DIVISION
_________ CON _________
In re:
________________________________
An Adult
PLAN OF CONSERVATOR OF PERSON
This plan should be developed in consultation with the ward, family members when
possible, and with input from any other community agencies involved in providing
services to the person.
I am the conservator of the person of the above named ward and my proposed plan for
providing services to the ward is as follows:
I. Living Arrangements for the Ward
My plan is for the ward to:
Continue to live at current residence
residence
Change
If changing residence, explain when, why and where ward will move:
I do not have enough information at this time to change the ward’s current living
arrangement.
I have discussed the housing plan with the ward, and the ward
agrees with this plan
does not agree with this plan
I have not discussed the housing plan with the ward because:
_____
II. Medical Care for the Ward
I plan to continue the medical services currently provided for the ward (provide
name of health care professionals):
Physician:
Psychiatrist or psychologist:
Social Worker or other case worker:
_____
Dentist:
Podiatrist:
_____
Dietician:
Therapist(s) (recreation, speech, physical, occupational):
Other:
I plan to seek a medical evaluation of the ward to determine the following:
___________________________________________________________
I believe the ward does not currently need treatment for any medical problems.
III.
Mental Health Treatment for the Ward
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I plan to continue the mental health services currently provided for the ward
(provide name of health care professionals):
Psychiatrist or psychologist:
Social Worker or other case worker:
_____
Other:
I plan to seek a mental health evaluation of the ward to determine the following:
___________________________________________________________
I believe the ward does not currently need mental health treatment.
IV. Social and Supportive Care for the Ward
In the next year, I plan to arrange the following services to assist the ward:
Educational or training programs
Vocational rehabilitation or supported work programs
Medical treatment, operation, or procedure
Mental health treatment
Occupational, physical, or speech therapy
Personal home care (e.g., home health aide)
Case management or social work services
Housing assistance and/or public benefits
Assistive devices or accommodation
Other (please specify):
V. Financial Care for the Ward
Do you have control over any assets or funds of the ward?
__________
No
Yes
I plan to investigate whether the ward has any type of insurance and whether the
ward is eligible for any private benefits or government entitlements.
I do not plan to investigate because another person has been appointed as
conservator of the property.
I do not plan to investigate because ____________________________________
___________________________________________________________________
___________________________________________________________________
VI. Other Information
Provide any other information that the Court should be aware of with regard to this
plan for the ward:
_____________________________________
________________________________________________________________
I have consulted with the following person(s) in preparing this plan (check all that
apply):
Ward
Family members of the ward
Friends of the ward
Care providers to the ward
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Ward’s attorney
Others (please specify):
VERIFICATION
I,
__________, being first duly sworn, on oath, depose
and say that I have read the foregoing pleadings by me subscribed and that the facts
therein stated are true to the best of my knowledge, information and belief.
__________
Signature of conservator of the person
__________
Address (Actual address/not Post Office Box)
__________
__________
Telephone number
__________
E-mail address (optional)
Subscribed and sworn to before me this
20______.
day
,
Notary Public/Clerk
CERTIFICATE OF SERVICE
I hereby certify that on the ____ day of ____________________, 20____, a copy of
the foregoing was served by first class mail, postage prepaid, to the following persons
(list names and addresses of all parties):
____________________________________
Signature
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