IN THE CIRCUIT COURT FOR THE TWENTY-THIRD JUDICIAL CIRCUIT DEKALB COUNTY, ILLINOIS PROBATE DIVISION Estate of ) ) __________________________________________) No. ___________________________________ A Disabled Person ) ANNUAL REPORT ON WARD Pursuant to Article 11a Section 17 (b) of the Probate Act of 1975, as amended, __________________________, (Guardian's Name) guardian of the ___________________________________ of the above-named ward, submits its annual report (person, estate, or both) as follows: 1. Age:_____ Mental Condition: __________________________________________________________ Physical Condition: ___________________________________________________________________ Social Condition: _____________________________________________________________________ 2. Present living arrangement of the ward: ___________________________________________________ ___________________________________________________ 3. Medical, educational, vocational, and other professional services given by others: Diagnosis: ____________________________________________________________________ Monitored by: _________________________________________ Current Weight: ________________ Medications: ___________________________________ Diet: ________________________________ Facility provides educational/vocational/social/PT-OT/speech services as needed. 4. Guardian's activities on behalf of ward: Personal visits: ______________________________________________________________________ Staffings/reviews attended: _____________________________________________________________ Various consents signed for placement, programming, release of information, medical needs. 5. 6. Appropriateness of placement: __________________________________________________________ Recommendation as to the need for continued guardianship: ___________________________________ ___________________________________________________________________________________. 7. Other information considered useful in the opinion of the guardian: Signed and sworn to before me this _____ day of _________________________. ________________________________________ Notary Public Signed by: __________________________ Address: ____________________________ ____________________________ Phone No.: __________________________ Probate44\Annual Report on Ward 11/16/2012 American LegalNet, Inc. www.FormsWorkFlow.com