SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE In the Guardianship of: No. ______________________________ Order Approving Personal Care Plan (ORAPRT) Initial Periodic Clerk's Action Required ______________________________, Incapacitated Person Guardianship Summary Due Dates Date Guardian Appointed: Date Letters of Guardianship Expire: Due Date for Periodic Personal Care Plan (GP): Guardian/Incapacitated Person _________________________ _________________________ _________________________ Certified Professional Guardian Non-Professional Guardian ( Training Required) Full Limited Estate Full Limited Person Relationship to Incapacitated Person _________________________________ Incapacitated Person (include facility contact) Full Name Mailing Address City, State, Zip ORDER APPROVING PERSONAL CARE PLAN (ORAPRT) SPO GDN 02.0330 Page 1 of 4 (12/2015) American LegalNet, Inc. www.FormsWorkFlow.com Guardian Individual LLC Incorporated *Telephone Number Facsimile Email Other Interested Parties Interested Party Full Name Mailing Address City, State, Zip *Telephone Number Facsimile Email Relation to Incapacitated Person Based upon the petition of the Guardian of the Person and the documents filed with the petition, the court makes the following: I. FINDINGS OF FACT The Personal Care Plan includes all of the facts necessary to give the court jurisdiction over this matter. No notice is required for the hearing on the report. Based upon the foregoing Findings of Facts, the Court now, therefore makes the following: II. CONCLUSIONS OF LAW The Initial Personal Care Plan Periodic Personal Care Plan should be approved. III. ORDER The Initial Personal Care Plan Periodic Personal Care Plan is approved. Interested Party The Clerk of the Court shall reissue letters of guardianship of the person only to __________________ (name of guardian) expiring on __________________. All prior letters of guardianship have expired. ORDER APPROVING PERSONAL CARE PLAN (ORAPRT) SPO GDN 02.0330 Page 2 of 4 (12/2015) American LegalNet, Inc. www.FormsWorkFlow.com The guardian shall cooperate with the Superior Court Guardianship Monitoring Program by providing to the program's designee access to the incapacitated person for in-home visits and access to any information, available to the guardian, including medical records, relating to the incapacitated person. The Court finds several previous Non Compliance Notices and/or Orders to Show Cause have been issued. In the event the next report is not filed timely and a Non Compliance and/or Order to Show Cause is issued a sanction of $____________ will be imposed. The Guardian's fees of $_______________, attorney fees of $______________ and administrative costs (DSHS cases only) of $_____________ payable during the period covered in this report are hereby approved. Guardian Total Fees Requested: $ Amount approved for advance: $ Additional fees Requested: $ Balance due (if approved): $ Administrative Costs ` $ (Medicaid cases only; hearing & notice to be given per WAC 388.79) Notice given to DSHS: Yes, (fees are over allowed amount) $ No, (fees do not exceed allowed amount) Attorney (court approval required) Accountant $ $ The advance of Guardian's fees for the upcoming reporting period, in the amount up to $ ______________ per month, appear to be reasonable and necessary but are subject to court approval at the next hearing. Above fees are approved for payment from the guardianship estate assets (after basic needs and personal allowance) OR as a monthly deduction from the incapacitated person's participation in the DSHS cost of care per WAC 388.79. The monthly deduction from the participation in cost of care is authorized for the next reporting period and 120 days thereafter. Dated ________________________. _____________________________________ Judge/Court Commissioner ORDER APPROVING PERSONAL CARE PLAN (ORAPRT) SPO GDN 02.0330 Page 3 of 4 (12/2015) American LegalNet, Inc. www.FormsWorkFlow.com Presented by: ________________________________ Signature of Guardian/Attorney ________________________________ Address ________________________________ *Telephone/Fax Number ______________________________ ____________ Print Name of Guardian/Attorney WSBA CPG# ___________________________________________ City, State, Zip Code ___________________________________________ Email Address *If you do not want your personal phone number on this public form, you may list your telephone number on a separate form which may be available to parties and the court, as well as its staff and volunteers, but will not be made available to the public. Use Form WPF GDN 03.0100, Guardianship Confidential Information form (Telephone Numbers), for this purpose. ORDER APPROVING PERSONAL CARE PLAN (ORAPRT) SPO GDN 02.0330 Page 4 of 4 (12/2015) American LegalNet, Inc. www.FormsWorkFlow.com