GN-4110, 05/18 Report and Recommendation of Guardian ad Litem (Annual Review of Protective Placement) 24724755.18(2) and 55.18(3)(d), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Name Date of Birth Amended Report and Recommendation of Guardian ad Litem (Annual Review) Case No. I am the court appointed guardian ad litem for the above-named ward. I certify to the court that I have complied with the requirements of a guardian ad litem under 24755.18 (2) (a) to (e), Wis. Stats., (except as noted in the section at the end of this report) and this Report is being filed within 30 days of my appointment. 1. I have reviewed Annual Report of the Review of the Status of the Ward, the Annual Report on the Condition of the Ward, and any other relevant reports on the ward 2. I have personally met with the ward and contacted the ward 3. I have orally explained to the ward and to the wardthe ward and the wardin writing, all of the following: A. The procedure for review of protective placement. B. The right of the ward to counsel, including when an attorney can be appointed. C. The right to an independent medical or psychological examination on the issue of competency (at county expense if the ward is indigent). D. The contents of the Annual Report of the Review of the Status of the Ward. E. That a change in or termination of protective placement may be ordered by the court. F. The right to a hearing and an explanation that the ward or the wardhearing. 4. I have reviewed the wardwardwhether the ward wishes to exercise any of the ward. Based on these reviews, I make the following report: A. Wards a nursing home. an intermediate facility. a center for developmentally disabled. a CBRF. an adult family home. Other: Name of Facility: Is the home or facility licensed for 16 beds or greater? No Yes B. The ward appears to continue to meet all the standards for protective placement. Yes No, please explain: C. The current protective placement is the least restrictive environment that is consistent with the ward's needs. Yes No, please explain: D. The ward has a developmental disability and placement is in a nursing home or intermediate facility, and the placement is the most integrated setting appropriate to the ward Not Applicable Yes No, please explain: D. The ward, the ward. No Yes, please explain: E. The ward or the ward No Yes, please explain: F. The ward or the wardbe appointed for the ward. No Yes, please explain: G. The ward or the wards a full due process hearing for the ward. N o Yes, please explain: I. The ward is not required to attend a Summary Hearing. Regarding the ward's attendance at a full due process hearing for this review: it is my opinion that the ward can attend the hearing in court. I waive the ward ability of the ward to understand and meaningfully participate, the effect of the ward American LegalNet, Inc. www.FormsWorkFlow.com GN-4110, 05/18 Report and Recommendation of Guardian ad Litem (Annual Review of Protective Placement) 24724755.18(2) and 55.18(3)(d), Wisconsin Statutes. This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 the importance of the proceedings and the ward. I certify the ward is unable to attend for these specific reasons: the ward is unable to attend the hearing in court because of residency in a nursing home or other facility, physical inaccessibility, or a lack of transportation; and the ward, advocate counsel, other interested person, or I request that the court hold the hearing in a place where the ward can attend. Specify location requested: 5. I recommend continued protective p lacement in the facility in which the ward resides at this time. Yes No, please explain: 6. Additional comments: Guardian ad Litem Name Printed or Typed Date American LegalNet, Inc. www.FormsWorkFlow.com