IN THE CIRCUIT COURT FOR FLORIDA IN RE: GUARDIANSHIP OF COUNTY, PROBATE DIVISION File No. Division ORDER APPOINTING LIMITED GUARDIAN OF THE PERSON (Limited Incapacity ­ Advance Directive) On the petition of the appointment of a limited guardian of the person of (the Ward), the Court makes the following findings: for 1. The Ward was adjudicated to be incapacitated by Order of this Court entered on , , and the Court, having considered alternatives to guardianship, found that no alternative to guardianship will sufficiently address the needs of the Ward, and that the restrictions imposed upon the Ward's rights and liberties are consistent with the Ward's welfare and safety, and are the least restrictive appropriate alternatives, reserving to the Ward the right to make decisions in all matters commensurate with the Ward's ability to do so. 2. Petitioner met the burden of establishing to the satisfaction of this Court the incapacity of the Ward to exercise the following delegable rights: () () () to determine his or her residence, to consent to medical and mental health treatment, to make decisions about his or her social environment or other social aspects of his or her life. The Court find that the Ward, prior to incapacity, appointed a health care surrogate pursuant 3. to Florida Statutes Chapter 765. 4. The nature of the guardianship is limited, and it is necessary to appoint a limited guardian of the person of the Ward. The Court having jurisdiction and being fully advised, it is ADJUDGED as follows: 1. appointed limited guardian of the person of is qualified to serve and is hereby . Bar Form No. G-3.071 - 1 of 2 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com 2. Order: () () () The following rights of the Ward are delegated to the guardian of the person appointed by the to determine the Ward's residence, to consent to medical and mental health treatment, unless such power has been retained by a health care surrogate as specified in this order, to make decisions about the Ward's social environment or other social aspects of the Ward's life. Upon taking the prescribed oath and filing designation of resident agent and acceptance, 3. letters of guardianship shall be issued. 4. The Ward's health care surrogate designation: ( ) is superseded and the guardian shall exercise all delegable rights otherwise assigned to the health care surrogate. ( ) shall remain in effect until further order of this court. ( ) shall remain in effect to the following extent: . ORDERED on , . Circuit Judge Bar Form No. G-3.071 - 2 of 2 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com