SUPERIOR COURT OF THE DISTRICT OF COLUMBIA PROBATE DIVISION _________ INT _________ In re: ________________________________ An Adult _________ IDD _________ REPORT OF VISITOR I, ______________________________, visitor, appointed by order entered on ___________ _______________________ submit the following report concerning the investigation that I conducted pursuant to D.C. Code, sec. 21-2033(c) and either sec. 20-2041(d) or sec. 20-2054(a) and Superior Court, Probate Division Rule 327. I. Interview of subject of proceeding [Visitor should attempt to make the below inquiries in terms comprehensible to the subject]: A. Date and place of interview: ________________________________________________ __________________________________________________________________________ B. Oriented by time and place? _______ Yes ______ No C. Physical appearance: _______________________________________________________ __________________________________________________________________________ D. Subject asked and responded as follows: 1. Do you understand my explanation of the substance of the petition; the nature, purpose, and effect of the proceeding; and the general powers and duties of a guardian and conservator? ______Yes _________No (If no, explain here) ______________________________________ ___________________________________________________________________________ 2. You have the right to retain an attorney at your own expense. If you cannot afford to pay an attorney, one will be provided by the Court without cost to you. Do you have an attorney? ____Yes ____No If yes, give name and address: _________________________________________________ ___________________________________________________________________________ 3. Do you understand that under the law you have the following rights: To be present in person at any court proceeding and to see or hear all evidence bearing on your condition ____Yes ____No To be represented by counsel ____Yes ____No 1 November 2015 ­ 943.10.v3 American LegalNet, Inc. www.FormsWorkFlow.com To present evidence and cross-examine witnesses, including any court-appointed visitor or physician ____Yes ____No To have a closed hearing on any issue To contest the petition To object to the appointment of the proposed guardian or conservator or their powers or duties To object to the creation of the proposed guardianship or conservatorship or guardian ad litem appointed to represent your interests if the Court determines that a need for such representation exists To have all or a portion of the compensation of any court-appointed visitor, attorney, guardian ad litem or physician paid by the Court or the petitioner if you cannot afford to pay it ____Yes ____No ____Yes ____No ____Yes ____No ____Yes ____No _____Yes ____No 4. Who are your closest family members? (Give name, address, and relationship: _______________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 5. Do you have a doctor? ________Yes ______No If yes, give name and address: ______________________________________________ ________________________________________________________________________ Is this the same doctor who provided a letter, if any, attached to the petition filed in these proceedings? ______Yes _______No 6. Do you need help caring for yourself or your finances? _____Yes ____No If yes, how: _____________________________________________________________ ________________________________________________________________________ 7. Who would you like to help care for you? _____________________________________ _________________________________________________________________________ 8. How are you currently caring for yourself? _____________________________________ _________________________________________________________________________ 2 November 2015 ­ 943.10.v3 American LegalNet, Inc. www.FormsWorkFlow.com _________________________________________________________________________ 9. Describe your income, assets, and liabilities: ___________________________________ __________________________________________________________________________ __________________________________________________________________________ 10. Do you know _____________________, the proposed guardian or conservator? ____Yes ____No a. How do you feel about having him/her make decisions about your day to day care? ___________________________________________________________________________ ___________________________________________________________________________ b. What decisions do you want your guardian or conservator to make? __________________ __________________________________________________________________________ c. If a guardian or conservator is appointed, what decisions would you like to make for yourself, and what actions (e.g. with respect to your property), would you like to take for yourself? ____________________________________________________________________________ ____________________________________________________________________________ d. How do you feel about what is requested in the petition? (Visitor should describe request.) ____________________________________________________________________________ e. Names of third person(s) present during the interview (if any) and their relationship to the subject: _____________________________________________________________________ II. Interview of person(s) seeking appointment as guardian or conservator: A. Date and place of interview: _________________________________________________ _________________________________________________________________________ B. Person(s) seeking appointment asked and responded as follows: 1. Name, address, home and business telephone numbers, and occupation: ___________________________________________________________________________ ___________________________________________________________________________ 2. Relationship to subject of the proceeding: _______________________________________ 3. Why does subject need help: _________________________________________________ __________________________________________________________________________ 4. Where has the subject resided during the last three months? __________________________________________________________________________ _____________________________