Exhibit A Limitations To Guardianship
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Exhibit A Limitations To Guardianship Form. This is a Massachusetts form and can be use in Probate And Family Court Statewide.
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Tags: Exhibit A Limitations To Guardianship, MPC 720A, Massachusetts Statewide, Probate And Family Court
Docket No.
EXHIBIT A
LIMITATIONS TO GUARDIANSHIP
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court
Division
In the Interests of:
First Name
Middle Name
Last Name
Incapacitated Person
Exhibit to
an Order or
a Decree and Order dated
The Incapacitated Person shall retain the following rights or responsibilities:
Care of Self
To be responsible for bathing, dressing, toileting, and dental care (with assistance).
To choose and determine daily meals.
Medical Decision Making and Management
To make and communicate decisions about health care, including the continuance or withdrawal of life sustaining
treatment.
To choose a health or longterm care facility.
To choose and direct home health care providers.
To manage medications (with assistance).
Home and Community Life
To choose to reside/live at home.
To be responsible for maintaining and cleaning the home (with assistance).
To be left alone (with time limit).
To drive with a valid driver's license.
To use public transportation independently.
To make and communicate choices about roommates.
To select and plan a schedule of daily and leisure activities.
To vote.
To smoke at a time and place of the incapacitated person's choosing, within the law.
To seek and obtain employment.
To travel.
To determine with whom to have friendships and visitation.
To determine how much to participate in religious activities.
To use the telephone or computer (without supervision).
To correspond with others and to use mail or email (without supervision).
MPC 720A (5/30/11)
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