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Annual Guardianship Plan Guardian Of Person (Adult) Form. This is a Florida form and can be use in Orange Local County.
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Tags: Annual Guardianship Plan Guardian Of Person (Adult), Florida Local County, Orange
IN THE CIRCUIT COURT FOR ORANGE COUNTY, FLORIDA
PROBATE/ MENTAL HEALTH DIVISION
IN RE: GUARDIANSHIP OF
File No. 48-_______________________________
ANNUAL GUARDIANSHIP REPORT
ANNUAL GUARDIANSHIP PLAN OF GUARDIAN OF PERSON
(Adult Ward)
__________________________________________________________________________________, the
guardian of the person of _____________________________________________________________________(the
Ward), submits the following plan as the Annual Guardianship Report of this guardian:
The Annual Guardianship Plan for the period beginning ________________________________________,
___________, and ending ____________________________, _________, shall be as follows:
1.
The Ward’s address at the time of filing this plan is ____________________________________
______________________________________________________________________________.
2.
During the preceding year, the Ward resided at (include dates, names, addresses and length of stay
at each place):
3.
The current residential setting (circle on) is or is not
Ward.
best suited for the current needs of the
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4.
Plans for ensuring that the Ward is in the best residential setting to meet the Ward’s needs during
the coming year are as follows:
5.
Description of professional medical treatment given to the Ward during the preceding year:
PHYSICIAN
TREATMENT
DATE
6.
Report of a physician who examined the Ward no more than 90 days before the beginning of the
report period is attached. Report contains an evaluation of the Ward’s condition and a statement
of the current level of capacity of the Ward.
7.
Plan for provision of medical, mental health and rehabilitative services in the coming year is as
follows:
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8.
Information concerning the social condition of the Ward is submitted as follows:
A. The social and personal services currently utilized by the Ward are:
B. State the social skills of the Ward, including how well the Ward maintains
interpersonal relationships with others:
C. Describe the Ward’s activities at communication and visitation:
D. Description of the social needs of the Ward:
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9.
Summary of activities during the preceding year designed to increase the capacity of the Ward:
10.
The Ward (circle one that applies) is or is not capable of having some or all of
his/her rights restored. If capable, identify rights that should be restored
11.
I/We (circle one) do or do not plan to seek the restoration of any rights to the Ward.
12.
This plan (circle one) has or has not been reviewed with the Ward to the extent
possible.
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 the ______ day of ___________________, _________.
___________________________________
Attorney for Guardian
____________________________________
Signature of Guardian
Florida Bar No.______________________
____________________________________
Signature of Co-Guardian
___________________________________
Address
___________________________________
____________________________________
Signature of Ward (if applicable)
___________________________________
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IN THE CIRCUIT COURT FOR ORANGE COUNTY, FLORIDA
PROBATE/ MENTAL HEALTH DIVISION
IN RE: GUARDIANSHIP OF
File No. 48-_______________________________
PHYSICIAN’S REPORT
1.
Name of Physician:
______________________________________________________________
Address:
______________________________________________________________
______________________________________________________________
______________________________________________________________
2.
Name of ward:
______________________________________________________________
3.
Date of examination:
______________________________________________________________
4.
Purpose of examination:
a.
b.
5.
Regular checkup ____________________________________________________________
Treatment for _______________________________________________________________
Evaluation of ward’s condition: (Specify mental and physical condition at time of exam)
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
6.
Description of ward’s capacity to live independently: ________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
7.
The ward (circle one) does or does not continue to need assistance of a guardian.
8.
Is the ward capable of being restored to capacity at this time?
9.
Date of this report: ___________________________________________________________________
10.
Signature of physician completing this report: _____________________________________________
(circle one) Yes or NO
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