Nevada > County > Washoe > District Court > Family
Annual Report Of Guardian On Condition Of Legally Incapacitated Person 1125 - Nevada
| Annual Report Of Guardian On Condition Of Legally Incapacitated Person Form. This is a Nevada form and can be used in Family District Court Washoe County . |
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1 CODE 1125 2 3 4 5 6 IN THE FAMILY DIVISION 7 OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA 8 IN AND FOR THE COUNTY OF WASHOE 9 IN THE MATTER OF 10 _________________________________, 11 A LEGALLY INCAPACITATED PERSON. Case No. __________________________________/ 12 Dept. No. 13 14 15 ANNUAL REPORT OF GUARDIAN ON CONDITION OF LEGALLY INCAPACITATED PERSON 16 1. I, _______________________ _________, am the Guardian of the above-named minor (NAME OF GUARDIAN) 17 and my annual report is as follows: 18 2. The present age of the Ward is __________________________. 19 3. Living arrangement: 20 a. The current address of the Ward is: __________________________________ 21 b. The Wards residence is: 22 ( ) own home/apt. ( ) nursing home ( ) Guardians home/apt. ( ) group home 23 ( ) hospital or medical facility ( ) relatives home _______________________ (RELATIONSHIP)24 c. The Ward has been in the present residence since _____________________. (DATE)25 If moved within the past year, state change(s) and reason(s) for change _____ 26 ______________________________________________________________ 27 ______________________________________________________________ 28 <<<<<<<<<********>>>>>>>>>>>>> 2 1 d. I rate the Wards living arrangement as: 2 ( ) excellent ( ) average ( ) below average 3 Explain ________________________________________________________ 4 ______________________________________________________________ 5 e. I believe the Ward is: 6 ( ) content with the living situation ( ) unhappy with the living situation 7 ( ) I recommend a more suitable living arrangement for the Ward as follows: 8 ______________________________________________________________ 9 ______________________________________________________________ 10 4. Physical health: 11 a. The Wards current physical condition is: 12 ( ) excellent ( ) good ( ) fair ( ) poor 13 b. During the past year, the Wards physical condition has: 14 ( ) remained about the same ( ) improved - explain _____________________ 15 ______________________________________________________________ 16 ( ) worsened - explain _____________________________________________ 17 ______________________________________________________________ 18 c. List below the names and address of the Wards treating physician(s) and 19 dentist, giving the date and purpose of the last visit: 20 DATE DR.S NAME AND ADDRESS AILMENT TREATMENT21 ______________________________________________________________ 22 ______________________________________________________________ 23 ______________________________________________________________ 24 ______________________________________________________________ 25 ______________________________________________________________ 26 ______________________________________________________________ 27 ______________________________________________________________ 28 - 2 - <<<<<<<<<********>>>>>>>>>>>>> 3 1 5. Mental health: 2 a. The adults current mental condition is: 3 ( ) excellent ( ) good ( ) fair ( ) poor 4 b. During the past year, the minors mental condition has 5 ( ) remained about the same ( ) improved - explain _____________________ 6 ______________________________________________________________ 7 ( ) worsened - explain _____________________________________________ 8 ______________________________________________________________ 9 c. During the past year, treatment or evaluation by a psychiatrist, psychologist, or10 social worker ( ) was ( ) was not provided.11 6. Social activities/services: 12 a. The adults current social condition is: 13 ( ) excellent ( ) good ( ) fair ( ) poor14 b. During the past year, the minors social condition has:15 ( ) remained about the same ( ) improved - explain _____________________16 ______________________________________________________________17 ( ) worsened - explain _____________________________________________18 ______________________________________________________________19 c. During the past year, the minor has participate in the following activities:20 ( ) recreational __________________________________________________21 ( ) educational __________________________________________________22 ( ) social _______________________________________________________23 ( ) occupational _________________________________________________24 ( ) no activities available 25 ( ) the minor refused to participate in any activities26 ( ) the minor was unable to participate in any activities27 28 - 3 -<<<<<<<<<********>>>>>>>>>>>>> 4 1 7. List of visits: 2 a. During the past year, I visited the adult as follows: ______________________ 3 ______________________________________________________________ 4 ______________________________________________________________ 5 b. The average amount of time I spend on each visit was ___________________ 6 c. The last time I visited with the adult was on ____________________________ (DATE) 7 8. Activities: 8 During the past year, I performed the following activities on behalf of the adult: 9 __________________________________________________ __________________ 10 ________________________________ ____________________ ________________ 11 ________________ ___________________ _________________________________ 12 9. I believe the adult has the following unmet needs: ___________________________ 13 ____________________________________________ ________________________ 14 ____________________________ ________________________ ________________ 15 10. The Guardianship ( ) should ( ) should not be continued because: 16 _______________ _____________________________________________________ 17 __________________________________________________ __________________ 18 11. I ( ) do ( ) do not have possession or control of the adults estate. If yes, my accounting19 is attached. 20 21 ___________________ ___________________________________________________ 22 DATE SIGNATURE ___________________________________________________ 23 ADDRESS ___________________________________________________ 24 CITY, STATE, ZIP ___________________________________________________ 25 TELEPHONE 26 27 28 - 4 - <<<<<<<<<********>>>>>>>>>>>>> 5 1 Under penalties of perjury, the undersi gned declares that he is the Guardian 2 named in the foregoing Account of Guardian and knows the contents thereof; that the 3 document is true of his own knowledge except as those matters stated upon information and 4 belief, and that as to such matters, he believes it to be true. 5 ___________________________________________________ GUARDIAN 6 7
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