Approved, SCAO OSM CODE: RPD STATE OF MICHIGAN REPORT TO ACCOMPANY PETITION TO FILE NO. PROBATE COURT APPOINT, MODIFY OR DISCHARGE COUNTY GUARDIAN OF INDIVIDUAL WITH CIRCUIT COURT - FAMILY DIVISION DEVELOPMENTAL DISABILITY In the matter of , an indivdual iwith an alleged developmental disability1. I, , report to the court that: Name (type or print) 2. The individuals developmental disability may be described as follows: Nature: Type: 3. The appended evaluations are current, take into account the individuals abilities, and were performed and signed by the following individuals: Evaluation Name Title Date Performed Mental Physical Social Educational Adaptive Behavior Social Skills 4. Appended to the report is a listing of all psychotropic medication, plus all other medication that the individual is receiving on a continuous basis, the dosage of the medication, and a description of the impact upon his or her mental, physical and educational condition, adaptive behavior, and social skills. should be modified 5. Guardianship is needed for the following reason(s): is not needed. PLEASE SEE OTHER SIDE Do not write below this line - For court use only PC 659 (3/00) REPORT TO ACCOMPANY PETITION TO APPOINT, MODIFY OR DISCHARGE GUARDIAN OF INDIVIDUAL WITH DEVELOPMENTAL DISABILITY MCL 330.1612; MSA 14.800(612)>>>> 26. The type and scope of guardianship services needed are as follows: 7. The recommendations and reasons for the most appropriate rehabilitation plan are as follows: 8. The recommendations and reasons for the most appropriate living arrangements are as follows: The guardian should be authorized to make application to place the individual in Name or type of facility . Date Signature of person preparing report Name of center or agency Address City, state, zip Telephone no.