Examining Physicians Or Psychologists Report {GN-3130}

Physician222s or Psychologist's ReportDO NOT SUBMIT THIS PAGE TO THE COURTExamining Physician222s or Psychologist222s Report INSTRUCTIONS cannot answer should be marked 223unknown.224 Type or print your answers neatly. You may supplement this report with STATEMENT TO BE READ TO THE INDIVIDUAL PRIOR TO EXAMINATION DEFINITIONS The loss or dysfunction of an individual222s brain cells to the extent that he or she is substantially American LegalNet, Inc. www.FormsWorkFlow.com Physician222s or Psychologist's Report Examining Physician222s oPsychologist222s Report the 223STATEMENT TO BE INDIVIDUAL PRIOR TO EXAMINATION?224 (If #1. is checked, proceed directly to #9.) American LegalNet, Inc. www.FormsWorkFlow.com Physician222s or Psychologist's Report individual222s participation in the examination the individual222s level of intelligence Describe the individual222s level of functional knowledge: Does the individual222s incap American LegalNet, Inc. www.FormsWorkFlow.com Physician222s or Psychologist's Report 226 (If 223No224, indicate whether the individual could exercise the right with approval of his/her guardian.) pply for an operator222s/driver222s license? the individual222s best interests? medication, and medical treatment that is in the individual222s best interests? the individual222s best American LegalNet, Inc. www.FormsWorkFlow.com Physician222s or Psychologist's Report If yes, is the individual222s incapacity permanent or likely to be permanent? ed 223NO224 to any part of #1 icipate if the hearing was held at the individual222s location. idual222s attendance at a hearing. If you have any additional comments you feel are important in evaluating the individual222s need for a guardianship American LegalNet, Inc. www.FormsWorkFlow.com