Supplement For Emergency Guardian Of Person {17.1A}

PROBATE COURT OF GEAUA COUNTY, OHIO JUDGE TIMOTHY J. GRENDELL IN THE MATTER OF THE GUARDIANSHIP OF: CASE NO. SUPPLEMENT FOR EMERGENCY GUARDIAN OF PERSON [R.C. 2111.49] This Supplement must be completed when there is a request for Emergency Guardianship. The following questions must be answered with specificity and item 1.C, page 1 of the Statement of Expert Evaluation, form 17.1 must be checked. A. Does the individual have a durable heath care power of attorney? why is it not being honored? If yes, B. Exact nature of emergency: C. Length of time emergency has existed, and why? D. Specific action required to prevent significant injury to the person: E. Ability of the alleged Incompetent to receive notice and give consent: F. Medical prognosis in detail if immediate action, within 24 hours, is not taken: G. Additional statements regarding condition, family, support services, etc: Note: Any above answers may be supplemented by attachments. Date and Time of Evaluation Licensed Physician Date of Report 17.1A SUPPLEMENT FOR EMERGENCY GUARDIAN OF PERSON 06/06 American LegalNet, Inc. www.FormsWorkFlow.com