IN THE CIRCUIT COURT OF THE TWENTIETH JUDICIAL CIRCUIT IN AND FOR LEE COUNTY, FLORIDA PROBATE DIVISION IN RE: GUARDIANSHIP OF File No.: Division: PHYSICIAN'S REPORT (Required by Florida Statues, Section 744.3675) 1. Name of Physician: Address: 2. 3. 4. Name of ward: Date of examination: Evaluation of ward's condition: (Specify mental and physical condition at time of examination) 5. Description of ward's capacity to live independently: 6. 7. 8. 9. The ward (does) (does not) continue to need the 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: American LegalNet, Inc. www.FormsWorkFlow.com