Report Of Examining Committee Member {G-2.051}

IN THE CIRCUIT COURT FOR FLORIDA IN RE: COUNTY, PROBATE DIVISION File No. Division an alleged incapacitated person REPORT OF EXAMINING COMMITTEE MEMBER The undersigned, being a member of the committee appointed to examine , reports that such examination, as directed by the Order Appointing Examining Committee, has been completed. comprehensive examination, with evaluations and recommendations, is as follows: I. GENERAL INFORMATION The report of the Name of person being examined Date of birth Residence of person Date and time of examination Names of all persons present during the examination If a person other than the subject of the examination answers questions posed to the alleged incapacitated person, specify the name of the person and the information provided. _______________________________ Name and address of extended care facility (if any) Alleged incapacity is DIAGNOSIS (short summary) ] Bar Form No. G-2.051 © Florida Lawyers Support Services, Inc. January 1, 2024 www.FormsWorkflow.com