Page 1 of 3 of Form J 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 INITIAL GUARDIAN AD VOCACY PLAN OF THE PERS ON (Form J ) , (name of Guardian Advocate) Guardian Advocate of the P erson of , (the person with a developmental disability ), submits the following Initial Guardian Advocacy Plan. 1. During the period beginning the month the Guardian Advocate was appointed and ending twelve months thereafter, the Guardian Advocate prop oses the following plan for the benefit of the person with a developmental disability : A. List the m edical, mental or personal care services to be provided for the best welfare of the person with a developmental disability : B. List the s ocial and personal services to be provided for the best welfare of the person with a developmental disability : C. What place and kind of residential setting is best suited for the needs of the person with a developmental disability : American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 of Form J D. Description of health and accident insurance and any other private or governmental benefits to which the person with a developmental disability may be entitled to meet any part of the cost of medical, mental health or related services provided to the person with a developmental disability : E. Physical and mental examinations necessary to determine the person with a developmental disability medical and mental health treatment needs, including names of those who will provide examinations and approximate dates for examinations: 2. The Guardian Advocate hereby attests that the Guardian Advocate has consulted with the person with a developmental disability and, to the extent reas wishes consistent with the rights retained by the person with a developmental disability under the plan, and to the maximum extent reasonable, the plan is in accordance with the wishes of the person with a developmental disability . 3. This Initial Guardian Advocacy Plan does not restrict the physical liberty of the person with a developmental disability more than is reasonably necessary to protect the person with a developmental disability from serious physical injury, illness or disease and provides the person with a developmental disability with medical care and mental health treatment for the person with a developmental disability s physical and mental health. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 of Form J 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. Executed this day of , 20 . I hereby certify that a true copy of the foregoing has been furnished by mail to (name of attorney for the person with a developmental disability) at (address of the attorney for the p erson with a developmental disability) this day of , 20 and to , (The person with a developmental disability ) . Signature of Guardian Advocate Printed Name of Guardi an Advocate American LegalNet, Inc. www.FormsWorkFlow.com