FORM # 531GC (01/2019) Page 1 of 8 62-5-101, 62-5-106, 62-5-304A, 62-5-407 STATE OF SOUTH CAROLINA ) ) COUNTY OF ) ) ) IN THE MATTER OF: ) PROBATE COURT USE ONLY , ) ) IN THE PROBATE COURT an alleged incapacitated individual ) ) CASE NUMBER - GC - - ) ) GUARDIAN AD LITEM REPORT The undersigned court-appointed Guardian ad Litem in this guardianship and/or protective proceeding submits the following report concerning the investigation which was conducted pursuant to S.C. Code Ann. 247 62-5-106. DURING MY INVESTIGATION, I INTERVIEWED THE FOLLOWING INDIVIDUALS: NAME OF PERSON INTERVIEWED: DATE OF INTERVIEW: METHOD OF INTERVIEW (e.g. in person, by phone ): 1. 2. 3. DURING MY INVESTIGATION, I REVIEWED THE FOLLOWING DOCUMENTS: TYPE OF DOCUMENT: PROVIDER OF THE DOCUMENT: 1. 2. 3. I. REPORT ON ALLEGED INCAPACITATED INDIVIDUAL: 1. Date and place of interview(s): 2. Was the alleged incapacitated individual (A.I.I.) oriented to the time and place? YES NO 3. Describe the s physical appearance: 4. Who are the A.I.I closest family members? 5. Does the A.I.I. have a primary care physician or other treating medical provider? YES NO American LegalNet, Inc. www.FormsWorkFlow.com FORM # 531GC (01/2019) Page 2 of 8 62-5-101, 62-5-106, 62-5-304A, 62-5-407 6. Does the A.I.I. have an attorney? YES NO If yes, 7. Please list any known medical diagnoses of the A.I.I. 8. What are the current care and treatment needs of the A.I.I.? 9. What are the future care and treatment needs of the A.I.I.? 10. The A.I.I. has been rated or found to be: (Check all that apply) Disabled; Mentally ill or incompetent; Chemically Dependent; or None of the above. 11. The A.I.I. would benefit from: (Check all that apply) Further education; Further training; Therapy or treatment; Medical aids or equipment; An operation or medical procedure(s); Structural living arrangements; Psychiatric treatment; or None of the above. 12. Pursuant to S.C. Code Ann. 247247 62-5-304A(A) and 62-5-407, as Guardian ad Litem, I believe that the A.I.I. should retain the following rights and powers: (Check the rights and powers you recommend the A.I.I. should retain.) a. Marry or divorce; b. Reside in a place of the choosing, and consent or withhold consent to any residential or custodial placement; c. Travel without the consent of a guardian; d. Give, withhold, or withdraw consent and make other informed decisions relative to medical, mental, or physical examinations, care, treatment, and therapies; e. Make end-of- application of any medical procedures intended solely to sustain life and consent or withhold consent to artificial nutrition and hydration; f. Consent or refuse to consent to hospitalization and discharge or transfer to a residential setting, group home, or other facility for additional care and treatment; g. Authorize disclosure of confidential information; American LegalNet, Inc. www.FormsWorkFlow.com FORM # 531GC (01/2019) Page 3 of 8 62-5-101, 62-5-106, 62-5-304A, 62-5-407 h. Operate a vehicle; i. Vote; j. Be employed without the consent of a guardian; k. Consent to or refuse educational services; l. Participate in social, religious, or political activities; m. Buy, sell, or transfer real or personal property or transact business of any type including, but not limited to, those powers conferred upon a conservator under S.C. Code Ann. 247 62-5-422; n. Make, modify, or terminate contracts; o. Bring or defend any action at law or equity; and p. Other: If necessary, please explain these recommendations. If additional space is needed, please use additional sheets and attach. 13. Is the A.I.I. capable of communicating, with or without reasonable accommodations, his or her wishes, interests, or preferences regarding the appointment of a guardian and conservator? YES NO If no, then proceed to Section II. 14. What is the plan of the A.I.I. to provide care for himself or herself? 15. What is the plan of the A.I.I to (i) manage his or her property or financial affairs, (ii) provide for his or her support, and/or (iii) provide support for his or her legal dependents? 16. If a Petition for guardianship is pending, how does the A.I.I. feel about the proposed guardianship and the proposed guardian? 17. If a Petition for conservatorship is pending, how does the A.I.I. feel about the proposed conservatorship and the proposed conservator? American LegalNet, Inc. www.FormsWorkFlow.com FORM # 531GC (01/2019) Page 4 of 8 62-5-101, 62-5-106, 62-5-304A, 62-5-407 II. REPORT ON THE PROPOSED GUARDIAN: (If there is not a Petition for Appointment of Guardian pending, proceed to Section III.) 18. Name of the proposed guardian: 19. Relationship of the proposed guardian to the A.I.I.: 20. Is the proposed guardian currently a primary caretaker for the A.I.I.? YES NO If no, who is? 21. What are the proposed glong-term plans for the A.I.I.? 22. Upon review of the proposed gthe ability of the proposed guardian to serve in this role? YES NO If yes, please explain your concerns. 23. Has DSS ever investigated the proposed guardian? YES NO If yes, please explain the circumstances and provide any information the DSS record revealed that you believe the Court should know. 24. Did your investigation of the proposed guardian reveal anything that you believe the Court should know? YES NO If yes, please explain. 25. Do you believe the proposed guardian is an appropriate person to serve as a guardian for the A.I.I. considering (i) his or her geographic location, (ii) his or her familial or other relationship, (iii) his or her ability to carry out the duties of the guardianship, (iv) his or her potential conflict of interests, (v) the wishes of the A.I.I., and (vi) the recommendations of the relatives of the A.I.I.? Provide a detailed response. 26. Did your investigation reveal any other person who should be considered to be appointed the guardian in this matter? YES NO If yes, please explain, including the name, address, telephone number, age, and relationship to the A.I.I. American LegalNet, Inc. www.FormsWorkFlow.com FORM # 531GC (01/2019) Page 5 of 8 62-5-101, 62-5-106, 62-5-304A, 62-5-407 III. REPORT ON THE PROPOSED CONSERVATOR (If there is not a Petition for Appointment of Conservator pending, proceed to Section IV.) 27. Name of the proposed conservator: 28. Relationship of the proposed conservator to the A.I.I.: 29. Is the proposed conservator currently the primary person assisting the A.I.I. with his or her finances? YES NO If no, who is? 30. What assets does the A.I.I. own or income does the A.I.I. receive that necessitates the need for a conservator? 31. Upon review of the proposed cregarding the ability of the proposed conservator to serve in this role? YES NO If yes, please explain your concerns. 32. Has DSS ever investigated the proposed conservator? YES NO If yes, please explain the circumstances and provide any information the DSS record revealed that you believe the Court should know. 33. Upon review of the proposed cof the proposed conservator to serve in this role? YES NO If yes, please explain your concerns. 34. Did your investigation of the proposed conservator reveal anything that you believe the Court should know? YES NO If yes, please explain. 35. Do you believe the proposed conservator is an appropriate person to serve as a conservator for the A.I.I. considering (i) his or her geographic location, (ii) his or her familial or other relationship, (iii) his or her ability to carry out the duties of the conservatorship, (iv) his or her potential conflict of interests, (v) the wishes of the A.I.I., and (vi) the recommendations of the relatives of the A.I.I.? Provide a detailed response. American LegalNet, Inc. www.FormsWorkFlow.com FORM # 531GC (01/2019) Page 6 of 8 62-5-101, 62-5-106, 62-5-304A, 62-5-407 36. Did your investigation reveal any other person who should be considered to be appointed the conservator in this matter? YES NO If yes, please explain, including the name, address, telephone number, age, and relationship to the A.I.I. IV. REPORT ON THE CONDITIONS OF PRESENT PLACE OF RESIDENCE AND FUTURE RESIDENCE 37. Date and time visited: 38. Address (including street, city, county, state, zip): 39. Type of abode: 40