IN THE COURT OF COMMON PLEAS ASHLAND COUNTY, OHIO DOMESTIC RELATIONS DIVISION Case No. Plaintiff/First Petitioner, vs./and ORDER APPOINTING GUARDIAN AD LITEM Defendant/Second Petitioner. It appearing to the Court that the best interests of the minor child(ren) in this case would be served and protected by appointing a Guardian ad litem, it is hereby ORDERED as follows: 1. for the minor children to wit: shall be appointed Guardian ad litem in this case for . 2. The shall deposit the sum of $ into the trust account of the Guardian ad litem on or before . Said deposit shall be applied to the billings filed by the Guardian ad litem with the Court, upon order of the Court. The Court may order additional deposits from time to time to pay the costs of the Guardian ad litem. The Court shall retain jurisdiction to reallocate the costs upon the conclusion of the case. 3. Upon presentation of a copy of this order to any agency, hospital, organization, school, person, or office, the Guardian ad litem shall be permitted to inspect and copy any records relating to the child(ren) without the consent of the child(ren) or parent and to discuss all matters pertinent to those records and the child(ren). If necessary, the parties shall execute releases which will enable the Guardian ad litem to access, review and obtain copies of any records or information pertaining to the child(ren). By requesting the services of a Guardian ad litem , the parties specifically authorize release of any and all health care records and/or any Protected Health Information as contemplated by HIPAA (45 CFR part 2, 45 CFR '160 et seq.) and any relevant provisions of Ohio law. The Guardian ad litem shall maintain all information received from any confidential source as confidential and shall not disclose the same except as the law permits. 4. The Guardian ad litem shall be given notice of and shall be permitted to appear at all hearings in this case relating to the child(ren). 5. The Guardian ad litem fees are in the nature of child support for purposes of dischargeability in bankruptcy. ________________________________ Judge/Magistrate Page 1 of 1 FORM 6.00 (Rev. 3/1/2017) American LegalNet, Inc. www.FormsWorkFlow.com