Minnesota > Statewide > District Court > Parental Notification
Report Of Guardian Ad Litem Or Petitioner (Abortion) JUV-202 - Minnesota
| Report Of Guardian Ad Litem Or Petitioner (Abortion) Form. This is a Minnesota form and can be used in Parental Notification District Court Statewide . |
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State of Minnesota County Judicial District: Court File Number: Case Type: District Court Parental Notification In the Matter of the Petition of: Report of the Guardian Ad Litem or Petitioner Date of Birth: I. MEDICAL INFORMATION 1. Has the Petitioner been examined by a physician? Date: 2. 3. 4. Have the abortion procedures and the medical risks been explained? Have the aftercare procedures been explained and understood? Has the Petitioner been informed and does Petitioner understand what to do if medical complications occur? Has the Petitioner given a true statement of her medical history to the physician? Did Petitioner's physician advise her of any additional risks to her health as a result of her medical history? Has the Petitioner given informed consent to the abortion? Yes Yes No No Yes No Yes No 5. Yes Yes No No 6. 7. II. Yes No COUNSELING INFORMATION 1. Has Petitioner received counseling regarding having an abortion? If yes, name and agency of counselor; Yes No 2. Has Petitioner received counseling as to pregnancy alternatives? a. abortion b. adoption Yes Yes Rev 01/02-D www.courts.state.mn.us/forms No No JUV202 State ENG Page 1 of 4 American LegalNet, Inc. www.FormsWorkflow.com c. marriage d. single parenthood 3. Does Petitoner feel she needs more counseling as to her decision to a. have an abortion? Has Petitioner been counseled as to possible emotional and psychological a. Problems she may experience after the abortion? Has Petitioner been counseled as to the methods of contraception that a. are available? Yes Yes No No Yes No 4. Yes No 5. Yes No III. PERSONAL INFORMATION 1. 2. 3. Does Petitioner wish to have an abortion? Has Petitioner been coerced by any other party as to this decision? Petitioner elects not to notify her parent(s) because: Yes Yes No No 4. 5. Does Petitioner live with her parents? What is Petitioner's source of financial income? Yes No 6. 7. 8. 9. Is Petitioner attending school? Grade What is the highest school grade level Petitioner has completed? Is Petitioner employed? Place of employment: Address Yes No Yes No Job title: 10. What are Petitioner's plans for the future (schooling, employment, etc.)? JUV202 State ENG Rev 01/02-D www.courts.state.mn.us/forms Page 2 of 4 American LegalNet, Inc. www.FormsWorkflow.com 11. State any additional information Petitioner wishes to bring to the court's attention relative to the proposed abortion: Dated: Guardian Ad Litem on behalf of Petition or Petitioner Relationship to Minor JUV202 State ENG Rev 01/02-D www.courts.state.mn.us/forms Page 3 of 4 American LegalNet, Inc. www.FormsWorkflow.com IV. RECOMMENDATION OF THE GUARDIAN AD LITEM A. Authorization to the physician without parental notification is recommended because: B. The minor is mature and capable of giving an informed consent, as evidenced by: C. The minor is not mature, but the proposed waiver of parental notification is in her best interests because: D. It is not recommended that authorization be granted because: Dated: Guardian Ad Litem JUV202 State ENG Rev 01/02-D www.courts.state.mn.us/forms Page 4 of 4 American LegalNet, Inc. www.FormsWorkflow.com
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