Guardians Annual Status Report (rev 8-18) 1 IN THE CIRCUIT COURT OF THE CITY OF ST. LOUIS STATE OF MISSOURI PROBATE DIVISION ) In the Estate of: ) ) , ) Estate No. ) Incapacitated/Disabled/Deceased. ) ANNUAL STATUS REPORT BY GUARDIAN OF ADULT 1. Present address of your Ward . Is this a private home nursing home residential care facility mental health or retardation facility . If your Ward has died, what was his/her date of death? . 2. Present address(es), telephone number(s), and email address(es) of all Guardians. 3. If your Ward does not reside with you, when was the last time you saw your Ward? . How often do you see your Ward? Daily Weekly Monthly Quarterly . Describe the nature of your contact with the Ward 4. Is the Ward able to participate in decisions regarding his/her health care and residential placement? . 5. If your Ward resides in a mental health or habilitation facility: Is there an individual support plan, treatment plan, or plan for future care for your Ward? . If yes, please attach a copy of the plan to this Report. 6. When was the last time you met with the treatment team? . Do you agree with the treatment plan? . If not, why? American LegalNet, Inc. www.FormsWorkFlow.com Guardians Annual Status Report (rev 8-18) 2 . 7. Provide the name, address and telephone number of your Ward222s physician. When did your Ward last see his/her physician? . What was the reason for the visits? . 8. Describe any major changes that you have observed in your Ward222s physical or mental condition since your last Annual Status Report or since you were appointed Guardian if this is your first Report. . 9. In your opinion, should this Guardianship be continued? . If not, why? 10. If, in your opinion, this Guardianship should continue, do believe that your current level of authority should remain the same? . If not, please describe how your authority should be either increased or decreased. . 11. Do you intend to change the Ward222s level of care during the coming year? . If yes, please describe the changes that you intend to make. . Guardian Date Guardian Date Please return this form by first class mail or email to: Probate Division, 22nd Judicial Circuit, 10th Floor, 10 North Tucker, St. Louis MO 63101, stlprobate@courts.mo.gov. American LegalNet, Inc. www.FormsWorkFlow.com