Page 1 of 5 of Form L IN THE CIRCUIT COURT, EIGHTEENTH JUDICIAL CIRCUIT IN AND FOR BREVARD COUNTY, FLORIDA CASE NO. : IN RE: THE GUARDIAN ADVOCACY OF Name of Person with a Developmental Disability ANNUAL GUARDIAN ADVOCACY PLAN (Form L ) Comes now , the Guardian A dvocate of the P erson of ( Person with a Developmental Disability ), and submits the following Annual Guardian Advocacy Plan: The Annual Guardian Advocacy Plan, for the period beginning ( Month) (Day) ( Year) and ending ( Month) (Day) and ( Year) , shall be as follows: 1 . The following information is submitted concerning the residence of the person with a developmental d isability : a. The person with a developmental d isability 's address at the time of filing this plan is: b. During the prior twelve (12) months the person with a developmental d isability has resided at the following locations (names, addresses, and length of stay at each location): American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 5 of Form L c. The residential setting best suited for the current needs of the person with a developmental d isability is as follows: d. The Plan for the next twelve (12) months to ensure the person with a developmental d isability is in the best residential setting to meet the person with a developmental d isability 's needs is as follows: 2. The following information is submitted concerning the medical and mental health conditions and treatment and rehabilitation needs of the person with a developmental d isability : a. Any professional medic al treatment given to the person with a developmental d isability during the prior twelve (12) months was as follows: b. Attached is a report of a physician who examined the p erso n with a developmental d isability no more than 90 days before the beginning of the applicable reporting period. The report contains an evaluation of the person with a developmental d isability 's physical and mental condition. c. The plan for providing medical, mental health and rehabilitative services in the next twelve (12) months is as follows: American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 5 of Form L 3. The following information is submitted concerning the social condition of the person with a d evelopmental d isability : a. The following is a summary of the social and personal services currently used by the person with a developmental d isability : b. The following is a statement of the social skills of the person with a developmental d isability , including how well the person with a developmental d isability communicates and maintains interperso nal relationships: c. The following is a description of the social needs of the person with a developmental d isability : 4. The following is a summary of activities during the preceding year designed to enhance the capacity of the person with a developmental d isability : American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 5 of Form L 5. Can any rights of the person with a d evelopmental d isability be restored ? ( Yes ) or ( No ) 6. Will the Guardian seek restoration of any rights of the person with a developmental d isability ? ( Yes ) or ( No ) Under penalties of perjury, I, G uardian Advocate , declare that I have read the foregoing and the facts alleged are true to the best of my knowledge and belief, and that I provided a copy of this plan to the person with a developmental d isability . Dated this day of , 20 . Signature of Guardian Advocate Printed Name of Guardian Advocate American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 5 of Form L (Form N ) (Required by 247 744.3675 (1)(b)2 ) , Fla. Stat.) 1. Name of Physician: 2. Address: 3. Name of Patient: 4. Date of Examination: 5. Purpose of Examination: a. Regular Check - up: b. Treatment: 6. Evaluation of person with a d evelopmental d isability c ondition: (Specify mental and physical condition at time of examination) 7. Description of person with a developmental d isability 8. The person with a developmental d isability (does) (does not) continue to need assistance of a Guardian. 9. Is the person with a developmental d isability capable of being restored to capacity at this time ? ( Yes) or (No) 10. Date of this Report: 11. Signature of Physician completing this Report: American LegalNet, Inc. www.FormsWorkFlow.com