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Order On Petition For Protective Placement Or Protective Services GN-4060 - Wisconsin
| Order On Petition For Protective Placement Or Protective Services Form. This is a Wisconsin form and can be used in Guardianship Circuit Court Statewide . |
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For Official Use STATE OF WISCONSIN, CIRCUIT COURT, Amended COUNTY IN THE MATTER OF Order on Petition for Protective Placement or Protective Services Case No. Date of Birth This matter is before the court on a Petition for Protective Placement/Protective Services and a hearing was held. The court considered the comprehensive evaluation, community plan (if required), testimony and other evidence presented and the guardian ad litem's report and recommendation. THE COURT FINDS: 1. JURISDICTION, VENUE, NOTICE AND EVALUATIONS TO COURT A. This court does does not have jurisdiction of the subject matter and of the person of the individual. B. This court is is not a proper venue. C. Notice was was not properly served. D. The individual is present. not present and the court accepts the waiver of presence by the guardian ad litem. E. Additional evaluations are not necessary. 2. FOR PROTECTIVE PLACEMENT A. The individual does not meet the standards for protective placement or need protective placement. B. The individual has a need for protective placement as follows: 1. The individual is eligible for protective placement because the individual has attained the age of 18 or is alleged to have a developmental disability and has attained the age of 14. 2. A petition for adult protective placement is being initiated not more than 6 months prior to the individual's birthday at which the individual first becomes eligible for placement. 3. A separate petition to transfer a foreign guardianship has been filed whether the individual is present in the state or not. 4. The individual was adjudicated incompetent in Wisconsin on this date . within the last 12 months of the filing of this petition for protective placement or services. more than 12 months prior to the filing of this petition for protective placement or services and the court reviewed the finding of incompetency and finds the individual continues to be incompetent. except in the case of a minor who is alleged to have a developmental disability. 5. The individual meets the standards for protective placement because: the individual has a primary need for residential care and custody. except in the case of a minor that is age 14 or older, who is alleged to have a developmental disability, the individual has either been adjudicated to be incompetent by a circuit court or a petition for guardianship was submitted on the minor's behalf; as a result of a developmental disability, degenerative brain disorder, serious and persistent mental illness, other like incapacities, the individual is so totally incapable of providing for the individual's own care or custody as to create a substantial risk of serious harm to the individual or others. Serious harm may be evidenced by overt acts or acts of omission. the individual has a disability that is permanent or likely to be permanent. GN-4060, 02/11 Order on Petition for Protective Placement or Protective Services Page 1 of 3 §46.279, Chapters 54 and 55, Wisconsin Statutes American LegalNet, Inc. www.FormsWorkFlow.com This form shall not be modified. It may be supplemented with additional material. Order on Petition for Protective Placement or Protective Services Page 2 of 3 Case No. 6. The least restrictive placement consistent with the individual's needs is placement in an unlocked unit. a locked unit because: 7. The recommended placement in the least restrictive environment and in the least restrictive manner consistent with the needs of the individual to be protected and with the resources of the county department, including the limits of available state and federal funds, and county funds required to be appropriated to match state funds is: (Name and address of placement) 8. The individual is determined to have a developmental disability and the most integrated setting appropriate for the individual's needs, and with the resources of the county department, and the limits of available state and federal funds, and county funds required to be appropriated to match state funds, is placement in: Center for developmentally disabled individuals. Nursing facility. Intermediate care facility. Non-institutional community placement. Other: 3. FOR PROTECTIVE SERVICES A. The individual does not meet the standards for protective services or need protective services. B. The individual needs protective services and meets the standards for protective services because: the individual was determined to be incompetent or is a minor alleged to have a developmental disability and a petition for guardianship was submitted, and as a result of a developmental disability, degenerative brain disorder, serious and persistent mental illness, other like incapacities, the individual will incur a substantial risk of physical harm or deterioration or will present a substantial risk of physical harm to others if protective services are not provided. 4. PETITIONER'S ATTORNEY FEES AND COSTS It is equitable inequitable to award payment of petitioner's reasonable fees and costs from the individual's income and assets. 5. FIREARMS RESTRICTION The individual has been adjudicated pursuant to 18 USC 922(g)(4) as a "mental defective" or committed to a mental institution. 6. Other: IT IS ORDERED: The petition is denied. granted as follows: 1. FOR PROTECTIVE PLACEMENT The county department or agency with which it contracts under §55.02(2), Wisconsin Statutes, or its designee shall provide protective placement to the individual in the least restrictive environment and in the least restrictive manner consistent with the needs of the individual and with the resources of the county department, including the limits of available state and federal funds, and county funds required to be appropriated to match state funds. 2. FOR PROTECTIVE SERVICES The county department or agency with which it contracts under §55.02(2), Wisconsin Statutes, or its designee shall provide protective services to the individual in the least restrictive environment and in the least restrictive manner consistent with the needs of the individual and with the resources of the county department, including the limits of available state and federal funds, and county funds required to be appropriated to match state funds. GN-4060, 02/11 Order on Petition for Protective Placement or Protective Services Page 2 of 3 §46.279, Chapters 54 and 55, Wisconsin Statutes American LegalNet, Inc. www.FormsWorkFlow.com This form shall not be modified. It may be supplemented with additional ma
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