For Official Use COUNTY STATE OF WISCONSIN, CIRCUIT COURT, Amended IN THE MATTER OF Summary Hearing Findings and Order Terminating Protective Placement Order for Protective Services (Annual Review of Protective Placement) Date of Birth Case No. This matter is before the court on a Petition for Annual Review of Protective Placement. The court has ordered a summary hearing and a summary hearing has been held. The court has considered the information contained in the county department’s annual report of the review of the status of the individual, Report and Recommendation of Guardian ad Litem (Annual Review) and any other relevant reports on the individual’s condition and placement. to order additional information, and not to order The court has determined to appoint adversary counsel. not to appoint A request for a full hearing has been withdrawn. THE COURT FINDS: 1. The individual continues to be incompetent. 2. The individual no longer meets the standards for protective placement. 3. The individual meets the standards for protective services because: the individual has been determined to be incompetent, or is a minor who is alleged to have a developmental disability and on whose behalf a petition for a guardianship has been submitted; and as a result of a developmental disability, degenerative brain disorder, serious and persistent mental illness, or other like incapacities, the individual will incur a substantial risk of physical harm or deterioration or will present a substantial risk of physical harm to others if protective services are not provided.     THE COURT ORDERS: 1. Protective placement is terminated. A. The individual shall be transferred or discharged from the individual’s current residential facility within 60 days of this order. The county department shall assist the residential facility with discharge planning for the individual including planning for proper residential living arrangements and the necessary support services for the individual. B. The individual no longer meets the standards for protective placement or the facility is licensed for fewer than 16 beds and a protective placement order is not required. 2. The county department or agency with which it contracts under §55.02(2), Wisconsin Statutes, or its designee shall provide protective services to the individual in the least restrictive environment and in the least restrictive manner consistent with the needs of the individual and the resources of the county department, including the limits of available state and federal funds, and county funds required to be appropriated to match state funds. THIS IS A FINAL JUDGMENT/ORDER FOR PURPOSES OF APPEAL. BY THE COURT: Distribution: 1. Original - Court 2. Individual 3. Individual’s Guardian 4. Individual’s Legal Counsel, if any 5. Guardian ad Litem 6. Individual’s agent under an activated power of attorney for healthcare, if any 7. Facility in which the individual resided when petition for annual review was filed 8. County Department of individual’s county of residence under §55.18(1)(a) 9. County Department of individual’s placement under §55.18(1m) Circuit Court Judge/Circuit Court Commissioner Name Printed or Typed Date GN-4130, 01/09 Summary Hearing Findings and Order Terminating Protective Placement (Annual Review of Protective Placement) §§55.08(1)(b), 55.12(3),(4),(5), 55.17(3)(c) and 55.18(3), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.FormsWorkFlow.com