Alaska > Statewide > Probate Guardianship
Guardianship Implementation Report And Inventory PG-205 - Alaska
| Guardianship Implementation Report And Inventory Form. This is a Alaska form and can be used in Probate Guardianship Statewide . |
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IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT____________________ In the Matter of the Protective Proceedings of: ) ) Name of Ward: ) ) Date of Birth: ) ) Residential location of ward: ) ) ) Ward's Telephone #: ) ) ) CASE NO. GUARDIANSHIP IMPLEMENTATION REPORT AND INVENTORY Instructions Please type or print clearly using black ink. In preparing the report, you must consult with the ward as much as possible. The court will treat the information in this report as confidential. If you are unable to complete this form without help, you may find assistance on the website of the Office of Public Advocacy (OPA): www.state.ak.us/guardianship. Your local library and court may also have a binder of helpful information entitled "Family Guardian Education Materials," prepared by the Alaska State Association for Guardianship and Advocacy. You may also call OPA at 269-3500 (in Anchorage), 451-5933 (in Fairbanks) or 1-877-957-3500. After completing this report, you must sign it under oath (or affirmation) in the presence of a notary public or court clerk. See last page. If you are a full guardian with the powers of a conservator, you must fill out the entire form. If you are a partial guardian and do not have the powers of a conservator (or if a separate conservator has been appointed), you do not need to fill out the financial information in paragraphs 10 through 15. The purpose of this report is to give the court as complete a picture as possible of the ward's current situation and what you are going to do to implement the guardianship plan. Information About Guardian Guardian's Name Mailing Address (box or street number) (city) (state) (ZIP) Check here if this mailing address is new. If you change your address, please notify the court. Residence Address (street address) Do you live with the ward? Relationship to ward: Page 1 of 12 Probate Rules 16(e)(1)(A), 16(e)(3) & 17(e) PG-205 (2/05)(cs) AS 13.26.117, 13.26.250 & 13.06.100 GUARDIANSHIP IMPLEMENTATION REPORT & INVENTORY American LegalNet, Inc. www.USCourtForms.com Daytime Phone (city) No (state) Yes In what areas do you have the authority to make decisions for the ward? housing medical care school & job training employment social & recreational activities financial management (you control ward's finances because you have conservator powers) Has a separate conservator been appointed for the ward? No Yes Name: If you are a private guardian charging fees, is there a court order authorizing payment of fees and establishing an hourly rate and maximum monthly amount as required by Probate Rule 16 and AS 08.26.110? Yes No I do not charge fees. Information About Ward 1. Housing. a. On the date you were appointed guardian, where did the ward live? Name of facility or place: Address: (street address) (city) (state) Type of Residence: nursing home assisted living home Where does the ward live now? In the same place described above. In a different place. Describe: If the ward lives in your home, do you charge the ward rent? If you live in the ward's home, are you paying rent? Yes Yes No No (ZIP) b. c. d. Have you discussed the ward's housing arrangement with the ward? Yes. Explain what the ward wants: No, because e. Do you plan to change the place where the ward lives? Explain why: No Yes, to f. If ward lives in a nursing home, assisted living home, group home or other facility, (1) Is this the least restrictive setting in which services can be provided to the ward? Yes No (2) Have you participated in developing the facility's care plan for the ward? Yes No. (3) Do you believe the facility's care plan is a good one for the ward (in the ward's best interests)? Yes No Explain: Page 2 of 12 Probate Rules 16(e)(1)(A), 16(e)(3) & 17(e) PG-205 (2/05)(cs) AS 13.26.117, 13.26.250 & 13.06.100 GUARDIANSHIP IMPLEMENTATION REPORT & INVENTORY American LegalNet, Inc. www.USCourtForms.com g. Are there any problems with providing meals, clothing, house cleaning or transportation for the ward? 2. Medical Care for the Ward. a. Ward's last physical exam. Date: Recommended treatment: Doctor: I do not know when the ward last had a physical examination. I believe a physical exam is not necessary at this time. I will schedule a physical exam as follows (state when and where): b. Does the ward require: Dental evaluation? Yes Eye examination? Yes Hearing evaluation? Yes If yes, state when and where planned: No No No c. Describe any other medical problems (physical or mental) the ward has, and describe what is being done or will be done about them: d. Describe any plans you have to change the care currently being provided for the ward's medical problems: e. Have you discussed these medical issues with the ward? Yes. Explain what the ward wants: No. Explain why not: f. Are there any problems providing medical care or treatment for the ward? Page 3 of 12 Probate Rules 16(e)(1)(A), 16(e)(3) & 17(e) PG-205 (2/05)(cs) AS 13.26.117, 13.26.250 & 13.06.100 GUARDIANSHIP IMPLEMENTATION REPORT & INVENTORY American LegalNet, Inc. www.USCourtForms.com g. h. Is a no-code (Do Not Resuscitate) provision in place for the ward? Yes No Did the ward, while the ward still had the capacity to do so, execute a durable power of attorney for health care or some other advance health care directive under AS 13.52.010 - .395 or another law? Yes No. If yes, who is the agent authorized to make health care decisions for the ward? 3. School and Job Training. a. Does the ward attend school or any type of job training? Yes. Describe studies (include name and location of school): No, because: b. c. Is there any type of education or training that would benefit the ward? Have you discussed this with the ward? Yes. Explain what the ward wants: No. Explain why not: 4. Work. a. Is the ward employed? No, because: Yes. Describe (include type of work, name of employer, address, phone, and how long employed): If not employed, would it be in the ward's best interests to obtain employment? Have you discussed this with the ward? Yes. Explain what the ward wants: No. Explain why not: 5. Social and Recreational Activities. a. Describe activities the ward enjoys: b. c. Page 4 of 12 Probate Rules 16(e)(1)(A), 16(e)(3) & 17(e) PG-205 (2/05)(cs) AS 13.26.117, 13.26.250 & 13.06.100 GUARDIANSHIP IMPLEMENTATION REPORT & INVENTORY American LegalNet, Inc. www.USCourtForms.com b. Have you been able to help make these activities available to the ward? c. Do you have any plans concerning additional social and recreational acti
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