Missouri > Local Circuit Courts > 22nd Circuit (St. Louis City) > Probate
Annual Status Report By Guardian Of Adult - Missouri
| Annual Status Report By Guardian Of Adult Form. This is a Missouri form and can be used in Probate 22nd Circuit (St. Louis City) Local Circuit Courts . |
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IN THE CIRCUIT COURT OF THE CITY OF ST. LOUIS STATE OF MISSOURI PROBATE DIVISION In the Estate of: __________________________, Incapacitated. ) ) ) ) ) ) Estate No. ________________ ANNUAL STATUS REPORT BY GUARDIAN OF ADULT 1. Present address of your Ward ________________________________________________ Date _________________________________________________________________________. of Birth of your Ward _________________________. nursing home facility residential care facility Is this a private home mental health or retardation ____________. If your Ward has died, what was his/her date of death? _________________________________________________________. 2. Present address(es) and telephone number(s) of all Guardians. _______________ _________________________________________________________________________________ ________________________________________________________________________________. 3. If your Ward does not reside with you, when was the last time you saw your Ward? __________________________________________________________. you see your Ward? Daily Weekly Monthly Quarterly How often do ________________. Describe the nature of your contact with the Ward _______________________________ _________________________________________________________________________________ ________________________________________________________________________________. 4. If your Ward resides in a mental health or habilitation facility: Is there a treatment plan for your Ward? ________. Do you have a copy of the treatment plan? ______? When was the last time you met with the treatment team? _______________. If not, why? ____________________ Do you agree with the treatment plan? _______. _________________________________________________________________________________ ________________________________________________________________________________. ANNUAL STATUS REPORT 1 American LegalNet, Inc. www.FormsWorkFlow.com 5. Provide the name, address and telephone number of your Ward's physician. _________________________________________________________________________________ ________________________________________________________________________________. When did your Ward last see his/her physician? _________________. What was the reason for the visits? __________________________________________________________ ________________________________________________________________________________. 6. Describe any major changes that you have observed in your Ward's physical or mental condition since your last Annual Status Report or since you were appointed Guardian if this is your first Report. __________________________________________ _________________________________________________________________________________ ________________________________________________________________________________. 7. In your opinion, should this Guardianship be continued? ____. If not, why? _________________________________________________________________________________ _________________________________________________________________________________ ________________________________________________________________________________. 8. If, in your opinion, this Guardianship should continue, should your powers be decreased or increased? _________________________________________________________ ________________________________________________________________________________. 9. In your opinion, is the present care of the Ward adequate? _____. If not, why? ____________________________________________________________________________ ________________________________________________________________________________. The foregoing is made under oath or affirmation and its representations are true and correct to the best knowledge and belief of the Guardian(s), subject to the penalties of making a false affidavit or declaration. ______________________________________ Guardian Date ________________________________________ Guardian Date Please return this form to: The 22nd 10th St. Probate Court Judicial Circuit Floor, 10 North Tucker Louis MO 63101 ANNUAL STATUS REPORT 2 American LegalNet, Inc. www.FormsWorkFlow.com
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