In the matter of First, middle, and last name , a legally incapacitated individual STATE OF MICHIGANPROBATE COURTCOUNTY OF ANNUAL REPORT OF GUARDIAN ONCONDITION OFLEGALLY INCAPACITATED INDIVIDUAL � FINAL REPORT FILE NO. 1. � I, en-USName (type or print)en-US , am the guardian of the adult named above and my annual � report for the period of en-USDateen-US to en-USDateen-US is as follows. 2. � Present age of the adult: en-US � Date of birth: en-US 3. � en-USLiving Arrangement � a. � The current address and telephone number of the adult are: � � b. � The name of the facility where the adult resides, if any: en-US Check here if this is a new addressen-US � c. � The adult's residence is: � own home/apartment � guardian's home/apartment � en-US other: en-US(boarding home, assisted living, etc.) � nursing home � en-US hospital or medical facility � foster home � en-US relative's home: en-USRelationship � d. � The adult has been in the present residence since en-USDateen-US . If moved within the past year, state � the changes and the reasons for change. � � en-US � e. � I rate the adult's living arrangement as � excellent. � average. � below average. � en-USExplain � en-US � en-US � en-US en-US � f. � I believe the adult is � content with the living situation. � en-US unhappy with the living situation. � � g. � I recommend a more suitable living arrangement for the adult as follows: en-US � en-US � en-US � en-US American LegalNet, Inc. www.FormsWorkFlow.com File No. 4. � en-USPhysical Health � a. � The adult's current physical condition is � excellent. � good. � fair. � en-US poor. � b. � During the past year the adult's physical condition has � � remained about the same. � � improved. � en-USExplain en-US � � worsened. � en-USExplain en-US � c. � During the past year the adult received the following medical treatment (include check-ups and dental work): en-US Dateen-US Ailmenten-US Type of Treatmenten-US Doctor222s Name 5. � en-USDo-Not-Resuscitate Order � � a. � I did not execute, reaffirm, or revoke a do-not-resuscitate order. � � b. � I � executed � reaffirmed � revoked � a do-not-resuscitate order for the adult under MCL 700.5314(d). � In doing so, I � did � did not � consult with the adult and his/her attending physician. � 6. � en-USPhysician Orders for Scope of Treatment (POST) Form � � a. � I did not execute, reaffirm, or revoke a POST form. � � b. � I � executed � reaffirmed � revoked � a POST form for the adult under MCL 700.5314(f). � In doing so, I � did � did not � consult with the adult and his/her attending physician. � 7. � en-USMental Health � a. � The adult's current mental condition is � excellent. � good. � fair. � en-US poor. � b. � During the past year, the adult's mental condition has � � remained about the same. � � improved. � en-USExplain en-US � � worsened. � en-USExplain en-US � c. � During the past year, treatment or evaluation by a psychiatrist, psychologist, or social worker � was � en-US was not � provided. 8. � en-USSocial Activities/Services � a. � The adult's current social condition is � excellent. � good. � fair. � en-US poor. � b. � During the past year, the adult's social condition has � � remained about the same. � � improved. � en-USExplain en-US � � worsened. � en-USExplain en-US en-US(SEE THIRD PAGE) American LegalNet, Inc. www.FormsWorkFlow.com File No. en-US8. en-US(continued) � c. � During the past year, the adult has participated in the following activities: � � recreational en-US � � educational en-US � � social en-US � � occupational en-US � � No activities were available. � � The adult refused to participate in any activities. � � The adult was unable to participate in any activities. 9. � en-USList of Visits � a. � During the past year, I visited the adult as follows: en-USList dates � � en-US � en-US � b. � The average amount of time I spent on each visit was en-US en-US . � c. � The last time I visited with the adult was on en-USDateen-US . 10. � en-USActivities � During the past year, I performed the following activities on behalf of the adult: en-US � en-US � en-US 11. � en-USConsultation � During the past year, I consulted with the adult before making the following decisions: en-US � en-US � en-US 12. � I believe the adult has the following unmet needs: en-US � en-US � en-US � 13. � The guardianship � should � should not � be continued because: en-US � � en-USNote: en-USIf you no longer wish to serve as guardian, you must file a petition to remove yourself. � � 14. � There � � is � � is not � more cash or property than what was previously reported to the court. � � If there is, specify the additional amount: � $ en-US en-US . � 15. As guardian, I have been ordered by the court to file an annual account, which is attached. en-USDate � en-USDate � en-USSignature of guardian � en-USSignature of co-guardian (if applicable) en-USAddress � en-USAddress � � en-USCity, state, zip Telephone no. � en-USCity, state, zip Telephone no. Check here if this is a new address � Check here if this is a new address � American LegalNet, Inc. www.FormsWorkFlow.com