IN THE CIRCUIT COURT FOR THE 14TH CIRCUIT, STATE OF FLORIDA GUARDIANSHIP, PROBATE AND MENTAL HEALTH DIVISION IN RE: THE GUARDIANSHIP OF ______________________________________ (Name of Guardian) INITIAL GUARDIANSHIP PLAN OF GUARDIAN OF PERSON (minor ward) rvd 2/16 ________________________, the guardian of the person of _______________________ (the minor ward), submits the following plan as the Initial Guardianship Plan of this guardian: CASE NO.: _________-CP 1. During the upcoming period beginning _____________, 20____and ______________, 20___, the guardian proposes the following plan for the benefit of the minor ward. a. Medical, mental or personal care services to be provided for the welfare of the minor ward (Which doctor(s) does the minor ward visit regularly? What kind of assistance does the ward require for activities of daily living? Does the ward require any mental health care?): __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ b. Name and location of the school the minor ward will attend, the minor ward's grade and a description of classes the minor ward will take (include the school's name, address and a list of the minor ward's grades): __________________________________________________________________________ __________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 1 American LegalNet, Inc. www.FormsWorkFlow.com c. Place and kind of residential setting best suited for the needs of the minor ward (include with whom the ward lives, an address and why this is the best placement for the minor ward): __________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ __________________________________________________________________________ d. Description of health and accident insurance and any other private or governmental benefits to which the minor ward may be entitled to meet any part of the costs of medical, mental health or related services provided to the minor ward (list all types of income/benefits received by or for the ward, for example, Social Security, child support, etc...): __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 2. The guardian attests that: The ward is a minor under the age of 14 or The guardian has consulted with the minor ward, and, to the extent _____a. _____b. reasonable, honored the minor ward's wishes consistent with the rights retained by the minor ward under this plan. 3. To the maximum extent reasonable, the plan is in accordance with the wishes of the minor ward. 2 American LegalNet, Inc. www.FormsWorkFlow.com 4. This Initial Guardianship Plan does not restrict the physical liberty of the minor ward more than is reasonably necessary to protect the minor ward or others for serious physical injury, illness or disease and provided the minor ward with care and appropriate supervision. Under penalties of perjury, I declare that I have read the foregoing and the facts alleged are true, to the best of my knowledge and belief. Signed on________________________ 20____. ______________________________ Attorney for Guardian Print Name: ___________________ Florida Bar No. _________________ Address: _______________________ _______________________________ Phone Number: (___) ___-________ ______________________________ Guardian Print Name: ___________________ Address: ______________________ ______________________________ Phone Number: (___) ___-________ CERTIFICATE OF SERVICE 1. Name_____________________________address_____________________________________ 2. Name_____________________________address_____________________________________ 3. Name_____________________________address_____________________________________ This__________day__________________20__________ _________________________________________ Signature 3 American LegalNet, Inc. www.FormsWorkFlow.com I certify that a copy of this Initial Plan has been served on: