IN THE CIRCUIT COURT FOR FLORIDA IN RE: GUARDIANSHIP OF COUNTY, PROBATE DIVISION File No. Division PHYSICIAN'S REPORT - ADULT WARD (Required by Florida Statutes, Section 744.3675) I. Name of Physician: Address: 2. 3. 4. Name of Ward: Date of examination: Purpose of examination: A. Regular checkup B. Treatment for 5. Evaluation of Ward's condition: (Specify mental and physical condition at time of examination) 6. Description of Ward's capacity to live independently: 7. 8. 9. 10. The Ward does does not continue to need assistance of a guardian. Yes No Is the Ward capable of being restored to capacity at this time? Date of this report: Signature of physician completing this report: Bar Form No. G-4.022 © Florida Lawyers Support Services, Inc. January 1, 2017 American LegalNet, Inc. www.FormsWorkFlow.com