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Annual Report Of Guardian On Condition Of Legally Incapacitated Individual PC 634 - Michigan
|Annual Report Of Guardian On Condition Of Legally Incapacitated Individual Form. This is a Michigan form and can be used in Guardianships and Conservatorships Probate Statewide .||
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Approved, SCAO OSM CODE: AGW STATE OF MICHIGAN ANNUAL REPORT OF GUARDIAN ON FILE NO. PROBATE COURT CONDITION OF COUNTY LEGALLY INCAPACITATED INDIVIDUAL CIRCUIT COURT - FAMILY DIVISION FINAL REPORT In the matter of , a legally incapacitated individual1. I, , am the guardian of the above named adult and my annual Name (type or print) report is as follows: 2. Present age of the adult: Date of birth: 3. Living Arrangement a. Current address and telephone number of the adult: b. The adults residence is: own home/apartment guardians home/apartment other: nursing home hospital or medical facility foster or boarding home relatives home: Relationship c. The adult has been in the present residence since . If moved within the past year, state Date the changes and the reasons for change: d. I rate the adults living arrangement as excellent. average. below average. Explain e. I believe the adult is content with the living situation. unhappy with the living situation. f. I recommend a more suitable living arrangement for the adult as follows: 4. Physical Health a. The adults current physical condition is excellent. good. fair. poor. b. During the past year the adults physical condition has remained about the same. improved. Explain worsened. Explain c. During the past year the adult received the following medical treatment (include check-ups and dental work): Date Ailment Type of Treatment Doctors Name (PLEASE SEE OTHER SIDE) Do not write below this line - For court use only MCL 700.5314(e), MCL 700.5317, MCR 5.409(A)PC 634 (9/02) ANNUAL REPORT OF GUARDIAN ON CONDITION OF LEGALLY INCAPACITATED INDIVIDUAL <<<<<<<<<********>>>>>>>>>>>>> 25. Mental Health a. The adults current mental condition is excellent. good. fair. poor. b. During the past year, the adults mental condition has remained about the same. improved. Explain worsened. Explain c. During the past year, treatment or evaluation by a psychiatrist, psychologist, or social workerwas was not provided. 6. Social Activities/Services a. The adults current social condition is excellent. good. fair. poor. b. During the past year, the adults social condition has remained about the same. improved. Explain worsened. Explain c. During the past year, the adult has participated in the following activities: recreational educational social occupational no activities available. the adult refused to participate in any activities. the adult was unable to participate in any activities. 7. List of Visits a. During the past year, I visited the adult as follows: List dates b. The average amount of time I spent on each visit was . c. The last time I visited with the adult was on . Date 8. Activities During the past year, I performed the following activities on behalf of the adult: 9. Consultation During the past year, I consulted with the adult before making the following decisions: 10. I believe the adult has the following unmet needs: 11. The guardianship should should not be continued because: 12. As guardian, I have been ordered by the court to file an annual account which is attached. Date Address Signature City, state, zip Telephone no.