GN-3160, 05/18 Report of Guardian ad Litem Guardianship Due to Incompetency 24724754.40, 54.42 , 54.44 and 55.10, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 5 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Name Date of Birth Amended Report of Guardian ad Litem Guardianship Due to Incompetency Case No. I am the court appointed Guardian ad Litem for the above-named individual and report to the court that I have completed the following duties and make the following report and recommendations: GENERAL DUTIES 1. INTERVIEWED INDIVIDUAL AND ADVISED INDIVIDUAL OF RIGHTS AND PROCEDURE On [Date] at [Place] , I interviewed the individual and explained to the individual the contents of the Petition; applicable hearing procedure; right to counsel, and right to request or continue a limited guardianship. I advised the individual, both orally, and in writing of the right to be present at the hearing; counsel, including when a lawyer can be appointed; an independent medical or psychological examination on the issue of competency; (at county expense if the person is indigent) a jury trial, and appeal. 2. INTERVIEWED PROPOSED GUARDIAN(S) I interviewed the proposed guardian, proposed standby guardian, if any, and any other person seeking appointment as guardian. 3. REVIEWED ADVANCE PLANNING I have reviewed any Power of Attorney for Health Care under ch.155; Durable Financial Power of Attorney under ch. 243 executed by the individual; other advance planning for financial and health care decision making in which the individual had engaged. 4. INTERVIEWED AGENT I have interviewed any agent appointed by the individual under any document specified above. 5. RECEIVED NOTICE OF HEARING AND COPIES OF REPORTS protective placement is being requested, I have received a copy of the comprehensive evaluation and, if applicable, the plan for home or community-based care. 6. PROVIDED NOTIFICATIONS attorney (if any) of the information contained below. I have also notified the appointed guardian (if any) of the duty to be present at and right to participate in the hearing; present and cross-examine witnesses; receive a copy of any comprehensive evaluation, and secure and present a report on an independent evaluation. REPORT AND RECOMMENDATIONS 7. OBJECTIONS The individual American LegalNet, Inc. www.FormsWorkFlow.com GN-3160, 05/18 Report of Guardian ad Litem Guardianship Due to Incompetency 24724754.40, 54.42, 54.44 and 55.10, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 5 does not does object to a finding of incompetency. does not does object to the proposed or present placement. does not does object to the recommendation of the guardian ad litem. is not is ambiguous on these matters. 8. ADVERSARY COUNSEL Adversary counsel is not is requested by the individual. Adversary counsel is not is recommended. 9. JURY TRIAL A jury trial is not demanded. is demanded. 10. at the hearing: It is my opinion the individual can attend the hearing in court. I waive attendance after considering the ability of the individual to understand and meaningfully participate, ychological health . I certify the individual is unable to attend for these specific reasons: The individual 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 individual, advocate counsel, other interested person, or I request that the court hold the hearing in a place where the individual can attend. Specify location requested: 11. ADDITIONAL EVALUATIONS Additional medical, psychological or other evaluation is not requested. is requested. Specify evaluation requested and reason: . 12. ADVANCED PLANNING is is not adequate to preclude the need for guardianship: . 13. BEST INTERESTS OF INDIVIDUAL Based on my investigation, I recommend that the court find that the individual is substantially capable of caring for himself or herself. incapable of caring for himself or herself. capable of managing his or her property. incapable of managing his or her property. 14. GUARDIAN OF THE PERSON A. Rights to be removed in full. If removed, these rights may not be exercised by any person. I recommend that the court declare the individual has incapacity to exercise the following rights to (1) execute a will. (2) serve on a jury. (3) register to vote or to vote in an election. B. Rights to be removed in full or exercised by individual only with consent of guardian of person. The individual has incapacity or limited capacity to exercise the following rights: (If any box is not checked , the individual retains that right in full.) Individual may not exercise this right. Remove right in full. Individual may exercise only with the consent of the Guardian of the Person. (1) consent to marriage. (3) apply for a fishing license. (4) apply for a license under Ch. 29, Wis. Stats., other than fishing. (5) apply for any other license or credential under 24754.25(2)(c)1.d., Wis. Stats. Specifically: (6) consent to sterilization. American LegalNet, Inc. www.FormsWorkFlow.com GN-3160, 05/18 Report of Guardian ad Litem Guardianship Due to Incompetency 24724754.40, 54.42, 54.44 and 55.10, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 3 of 5 (7) consent to organ, tissue, or bone marrow donation. C. Powers to be transferred to guardian of the person in full or in part. I recommend the court transfer to the guardian of the person to exercise the power in full or in part to 1. A. give informed consent to the voluntary receipt by the individual of a medical examination, medication, including any appropriate psychotropic medication, and medical treatment that is in best interest, if the guardian has first made a good - faith attempt to discuss with individual the voluntary receipt of the examination, medication, or treatment and if individual does not protest. Full Transfer. Partial Transfer. The individual retains the power to: 1. B. give informed consent, if in the best interests, to the involuntary administration of a medical examination, medication other than psychotropic medication, and medical treatment that is in the individual best interest. Full Transfer. Partial Transfer. The individual retains the power to: 2. project might help the individual, or others if minimal risk of harm. Full Transfer. Partial Transfer. The individual retains the power to: 3. others if greater than minimal risk of harm to the individual but evidence indicates individual would have elected to participate. Full Transfer. Partial Transfer. The individual retains the power to: 4. Full Transfer. Partial Transfer. The individual retains the power to: 5. give informed consent to receipt by individual of social and supported living services. Full Transfer. Partial Transfer. The individual retains the power to: 6. give informed consent to release of confidential records other than court, treatment, and patient health care records and redisclosure as appropriate. Full Transfer. Partial Transfer. The individual retains the power to: 7. make decisions related to mobility and travel. Full Transfer. Partial Transfer. The individual retains the power to: 8. choose providers of medical, social, and supported living services. Full Transfer. Partial Transfer. The individual retains the power to: 9. make decisions regarding educational and vocational placement and support services or employment. Full Transfe r. Partial Transfer. The individual retains the power to: 10. make decisions regarding initiating a petition for termination of marriage. Full Transfer. Partial Transfer. The individual retains the power to: 11. receive all notices on behalf of the individual. Full Transfer. Partial Transfer. The individual retains the power to: 12. act in all proceedings as an advocate of the individual, except the power to enter into a contract that binds the individual or the ind ividual in any legal proceeding pertaining to the property, unless the guardian of the person is also the guardian of