1 2 3 4 5 6 7 8 9 10 11 IN THE SUPERIOR COURT OF STATE OF WASHINGTON IN AND FOR THE COUNTY OF KING In the Guardianship of: _____________________________, 12 13 14 An Alleged Incapacitated Person. ) ) ) ) ) ) ) ) ) ) Case No.: ORDER APPOINTING GUARDIAN AD LITEM AND NOTICE OF HEARING RCW 11.88.090 (ORAPGL) (CLERK’S ACTION REQUIRED Paragraph 2.1,2.2,2.3) 15 16 FINDINGS OF FACT The Court finds: 17 1.1 The facts set forth in the Petition include those necessary to give the Court jurisdiction 18 over this matter. 19 1.2 Pursuant to RCW 11.88.090, a Guardian ad Litem should be appointed. 20 1.3[ 21 County Guardian ad Litem registry; or 22 23 1.4[ ] The Guardian ad Litem should be the person whose name next appears on the King ] The Guardian ad Litem should not be the person whose name next appears on the registry because the Court finds extraordinary circumstances exist as follows: ______________________________________________________________________. 24 1.5[ 25 Incapacitated Person would result in a substantial hardship upon such person because 26 ________________________________________________________________. ] Payment of the filing fee, and the fees-costs of the Guardian ad Litem by Alleged ORDER APPOINTING GUARDIAN AD LITEM AND NOTICE OF HEARING- 1 12/2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 ORDER The Court orders: 2.1 [ ] The Clerk’s filing fee is waived The hearing on the Guardianship petition shall occur (within 60 days of this hearing): 4 2.2 [ 5 [ 6 Department: ______________________________ 7 Address: ______________________________ 8 9 10 ] Date to be set by separate notice; OR ] Date: ______________________________ Hour: _______________ 2.3 Guardian ad Litem: ______________________________ is found or known by the Court to be a suitable disinterested person with the requisite knowledge, training or expertise, who is hereby appointed as Guardian ad Litem for the above-named person. The address and/or phone/fax 11 or the Guardian ad Litem are: ______________________________________. 12 [ 13 exceed $__________ per hour up to a maximum of $__________ without further, prior 14 Court approval. Should evidence hereafter be submitted showing that hardship did not exist 15 16 17 ] The Guardian ad Litem shall be appointed at public expense, to be paid at a rate not to or no longer exists, the Court shall reimburse the filing fee and all other fees and costs. [ ] The Guardian ad Litem shall be appointed at private expense. The Guardian ad Litem shall be paid at a rate of $__________ per hour up to ________(hours/dollars) without further order from the court. These amounts may be increased or modified only upon 18 application to the court in advance of the Guardian ad Litem providing further services. An 19 application to increase the fee limits shall be presented upon notice to all parties. 20 2.4 The Guardian ad Litem shall have the following duties as mandated by statute:(A) To 21 file within five days of receipt of Notice of Appointment, and serve all parties personally or 22 23 24 by certified mail with return receipt requested, his or her written statement of qualifications required by RCW 11.88.090(3)(b), which shall include all information required by RCW 11.88.090(3)(b). (B) To meet and consult with the Alleged Incapacitated Person as soon as practicable 25 following appointment and explain, in language which such person can reasonably be 26 expected to understand, the substance of the petition, the nature of the resultant proceedings, ORDER APPOINTING GUARDIAN AD LITEM AND NOTICE OF HEARING- 2 12/2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.FormsWorkFlow.com 1 the person’s right to contest the petition, the identification of the proposed Guardian or 2 Limited Guardian, the right to a jury trial on the issue of his or her alleged incapacity, the 3 right to independent legal counsel as provided by RCW 11.88.045, and the right to be 4 5 6 present in court at the hearing on the petition; (C) To determine whether mediation may be appropriate in the matter and if so, to bring a motion before the court. (D) To obtain a written report according to RCW 11.88.045 and such other written or oral 7 reports from other qualified professionals as are necessary to permit the Guardian ad Litem 8 to complete the report required by RCW 11.88.090 and to advise Alleged Incapacitated 9 Person of the identity of the health care professional selected by the Guardian ad Litem to 10 11 12 13 prepare the medical report. If Alleged Incapacitated Person opposes said health care professional selected by the Guardian ad Litem , the Guardian ad Litem shall use the health care professional selected by Alleged Incapacitated Person , but may obtain a supplemental examination by a different physician or psychologist or advanced certified nurse practitioner; 14 (E) Pursuant to 45 C.F.R. 164.514, all providers who are covered entities under HIPAA and 15 their business associates and upon verification of the authority of the Guardian ad Litem to 16 receive the required information, shall release to the Guardian ad Litem a copy of the 17 medical report required by RCW 11.88.045. 18 19 20 (F) To meet with the person whose appointment is sought as Guardian or Limited Guardian and ascertain: (i) The proposed Guardian’s knowledge of the duties, requirements, and limitations of a Guardian; 21 (ii) 22 the needs of Alleged Incapacitated Person. The steps the proposed Guardian intends to take or has taken to identify and meet 23 (G) To consult as necessary to complete the investigation and report required by RCW 24 11.88.090 with those known relatives, friends, or other persons the Guardian ad Litem 25 26 determines to have had a significant, continuing interest in the welfare of Alleged Incapacitated Person: ORDER APPOINTING GUARDIAN AD LITEM AND NOTICE OF HEARING- 3 12/2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.FormsWorkFlow.com 1 (H)To investigate alternate arrangements made or which might be created, by or on behalf 2 of the Alleged Incapacitated Person, such revocable or irrevocable trusts, durable powers 3 attorney or blocked account; whether good cause exists for any such arrangements to be 4 5 6 discontinued; and why such arrangements should not be continued or created in lieu of a Guardianship: (I)To provide the Court with a written report which shall include the following: (i) A description of the nature, cause and degree of incapacity, and the basis upon 7 which this judgment was made; 8 (ii) 9 probable residential requirements of the Alleged Incapacitated Person and the basis upon 10 11 12 13 A description of the needs of the Incapacitated Person for care and treatment, the which these findings were made; (iii) An evaluation of the appropriateness of the Guardian or Limited Guardian whose appointment is sought and a description of the steps the proposed Guardian has taken or intends to take to identify and meet current and emerging needs of the Alleged Incapacitated Person; 14 (iv) 15 Incapacitated Person or which could be made, and whether and to what extent such 16 alternatives should be used in lieu of a Guardianship, and if the Guardian ad Litem is 17 recommending discontinuation of any such arrangements, specific findings as to why 18 19 20 A description of any alternative arrangements previously made by the Alleged such arrangements are contrary to the best interest of the Alleged Incapacitated Person; (v) A description of the abilities of the Alleged Incapacitated Person and a recommendation as to whether a Guardian or Limited Guardian should be appointed. If appointment of a Limited Guardian is recommended, the Guardian ad Litem shall 21 recommend the specific areas of authority the Limited Guardian should have and the 22 limitations and disabilities to be placed on the Alleged Incapacitated Person; 23 (vi) 24 exercise the right to vote and the basis upon which the evaluation is made; An evaluation of the Alleged Incapacitated Person’s mental ability to rationally 25 26 ORDER APPOINTING GUARDIAN AD LITEM AND NOTICE OF HEARING- 4 12/2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.FormsWorkFlow.com 1 (vii) 2 Person concerning the proposed Guardian or Limited Guardian or Guardianship or 3 Limited Guardianship; 4 5 6 Any expression of approval or disapproval made by the Alleged Incapacitated (viii) Identification of persons with significant interest in the welfare of the Alleged Incapacitated Person who should be advised of their right to request special notice of proceedings pursuant to RCW 11.92.150; and (ix) Unless independent counsel has appeared for the Alleged Incapacitated Person, 7 an explanation of how the Alleged Incapacitated Person responded to the advice of the 8 right to jury trial, to independent counsel, and to present at the hearing on the petition. 9 (J) Within forty-five days after notice of commencement of the Guardianship proceeding 10 11 12 13 has been served upon the Guardian ad Litem, and at least fifteen days before the hearing on the petition, unless an extension or reduction of time has been granted by the Court for good cause, the Guardian ad Litem shall file a report and send a copy to the Alleged Incapacitated Person and his or her counsel, spouse, all children not residing with a notified person, those persons described in (I)(viii) of this subsection, and persons who have filed a request for 14 special notice pursuant to RCW 11.92.150. If the Guardian ad Litem needs additional time 15 to finalize his or her report, then the Guardian ad Litem shall petition the Court for a 16 postponement of the hearing or, with the consent of all other parties, an extension or 17 reduction of time for filing the report. If the hearing does not occur within sixty days of 18 19 20 filing the petition, then upon the two-month anniversary of filing the petition and on or before the same day of each following month until the hearing, the Guardian ad Litem shall file interim reports summarizing his or her activities on the proceeding during that time period as well as fees and costs incurred. 21 (K) To advise the Court of the need for appointment of counsel for the Alleged 22 Incapacitated Person within five court days after the meeting described in (A) of this 23 subsection unless (i) counsel has appeared, (ii) the Alleged Incapacitated Person 24 affirmatively communicated a wish not to be represented by counsel after being advised of 25 26 the right to representation and of the conditions under which court-provided counsel may be available, or (iii) the Alleged Incapacitated Person was unable to communicate at all on the ORDER APPOINTING GUARDIAN AD LITEM AND NOTICE OF HEARING- 5 12/2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.FormsWorkFlow.com 1 subject, and the Guardian ad Litem is satisfied that the Alleged Incapacitated Person does 2 not affirmatively desire to be represented by counsel. 3 (L) The Guardian ad Litem shall provide the Court with a working copy of the Guardian ad 4 5 6 Litem report pursuant to local rule or custom. (M) The Guardian ad Litem shall have the authority, in the event that the Alleged Incapacitated Person is in need of emergency life-saving medical services and is unable to consent to such medical services due to incapacity pending the hearing on the Petition, to 7 give consent for such emergency life saving medical services on behalf of the Alleged 8 Incapacitated Person. 9 (N) At any time during the course of the Guardian ad Litem’s appointment he/she may 10 11 12 13 petition the Court for additional instruction and authorization to undertake specific duties, including but not limited to consent for medical treatment beyond which is provided in paragraph (M) above. (O) The Court also ORDERS: _______________________________________________________________________ 14 _______________________________________________________________________ 15 _______________________________________________________________________ 16 DATED AND SIGNED IN OPEN COURT THIS __ DAY OF ________, 200___. 17 Judge/Court Commissioner 18 19 20 21 22 Presented by: Signature Printed Name Address Telephone/Fax Number City, State, Zip Code Email Address 23 24 25 26 ORDER APPOINTING GUARDIAN AD LITEM AND NOTICE OF HEARING- 6 12/2005 REVISED GUARDIANSHIP FORMS American LegalNet, Inc. www.FormsWorkFlow.com