Temporary Order-Decree And Order Of Expansion-Modification-Limitation
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Temporary Order-Decree And Order Of Expansion-Modification-Limitation Form. This is a Massachusetts form and can be use in Probate And Family Court Statewide.
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Tags: Temporary Order-Decree And Order Of Expansion-Modification-Limitation, MPC 701, Massachusetts Statewide, Probate And Family Court
TEMPORARY ORDER OF
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court
Docket No.
DECREE AND ORDER OF
EXPANSION
MODIFICATION
LIMITATION
OF THE POWERS OF A GUARDIAN
In the Interests of:
First Name
Division
Middle Name
Last Name
Incapacitated Person (Respondent)
On the Petition for:
Expansion
Modification
Limitation
of the Powers of a Guardian filed on
.
The Court finds that:
Expansion
Modification
Limitation
of the Powers of the Guardian
is appropriate, that notice has been properly
(name)
given to the Respondent and all other notice has been properly given or waived, and that it is in the best interests of the
Respondent that the powers of the Guardian be:
EXPANDED. The Court orders the Guardian's powers are expanded to include the following power(s) to:
admit Respondent to a nursing facility;
revoke the Health Care Proxy of Respondent;
apply for health insurance benefits including MassHealth on behalf of Respondent;
Obtain copies of statements or any other records from banks, insurance companies or other financial institutions
verifying balances and transactions for accounts standing in the name of the Incapacitated Person, individually or
jointly with another.
Other:
EXPANDED. After making a substituted determination (see separate findings), the court authorizes treatment
of the Incapacitated Person:
with antipsychotic medication in accordance with a treatment plan dated
which is incorporated herein by reference and which shall be reviewed on or before
and, if not sooner extended, shall expire on
. The appointment of Counsel for the
Incapacitated Person is extended for the limited purpose of representing the Incapacitated Person's interests in any
proceeding to renew and/or amend the treatment plan.
MPC 701 (5/30/11)
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Docket No.
In the Interests of:
First Name
Middle Name
Last Name
for the following treatment or action:
MODIFIED. The Court orders the Guardian's powers be modified as follows:
LIMITED. The Court orders the Guardian's powers be limited as follows:
The Court further Orders that:
This is a Temporary Order and the expansion, modification, or limitation of the powers of the Guardian stated herein
shall expire in ninety (90) days or on
.
(date)
Date:
JUSTICE OF THE PROBATE AND FAMILY COURT
MPC 701 (5/30/11)
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