Court Visitor Report

(Copy Receipt) (Clerk's Date Stamp) SUPERIOR COURT OF WASHINGTON COUNTY OF SPOKANE In the Guardianship of: ___________________________________ An Alleged Incapacitated Person CASE NO. __________________________ GUARDIAN AD LITEM REPORT RCW 11.88.090 (RTGAL) RECOMMENDATION: _______________________________________________________ 1. Procedural History. Date of Appointment: ____________________________________ Date of Service of Copy of Petition on Guardian ad Litem: ______________________________ Date Guardian ad Litem's Statement of Qualifications was filed & served: __________________ I attest that I am on the Guardian ad Litem Registry for this County, have conducted approximately ________ Title XI Guardian ad Litem investigations, and am qualified to serve as Guardian ad Litem in Guardianship matters. 2. Medical/Psychological Report. As required by RCW 11.88.045, I have obtained a written, medical/psychological report from ________________________________. The report was filed with the Court on _______________________. (Do not attach medical report to GAL report.) The examining physician/psychologist/advanced registered nurse practitioner was selected by _______________________________. The reason for selecting this individual to prepare the medical/psychological report was _________________________________________________ ____________________________________________________________________________ GUARDIAN AD LITEM REPORT - PAGE 1 OF 6 SPO GDN 02.0700 (03/2007) American LegalNet, Inc. www.FormsWorkFlow.com 3. Meeting(s) with Alleged Incapacitated Person. Dates of Meetings with Alleged Incapacitated Person Location of Meeting Other Persons Present (GAL must meet alone at least once with Alleged Incapacitated Person.) A. Personal Information Regarding Alleged Incapacitated Person: Date of Birth: Age: Current Residence: Telephone Numbers: DSHS Client Number: B. Incapacitated Person's Responses Regarding Specific Issues: Agreement or objection to appointment of a Guardian: Reaction to the proposed Guardian: Right to counsel: Preferences regarding choice of counsel: Right to a jury trial: C. Summary of Interviews with Alleged Incapacitated Person and Guardian ad Litem's Impressions. (Report as closely as possible the Alleged Incapacitated Person's own words when appropriate.) ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 4. Investigation. A. Individuals Contacted. (Name each person contacted and date(s) of contact. Explain the relationship of the interviewed person with the case or Alleged Incapacitated Person and what information that person contributed to your understanding the circumstances surroundings the Guardianship Petition.) GUARDIAN AD LITEM REPORT - PAGE 2 OF 6 SPO GDN 02.0700 (03/2007) American LegalNet, Inc. www.FormsWorkFlow.com ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ B. Written Materials Reviewed. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 5. Nature, Cause and Degree of Incapacity ­ Functional Limitations. A. Medical Diagnosis and Cause. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ B. Degree of Incapacity. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 6. Alternatives to Guardianship. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 7. Abilities of Alleged Incapacitated Person and Degree of Assistance Required. _____________________________________________________________________________ _____________________________________________________________________________ GUARDIAN AD LITEM REPORT - PAGE 3 OF 6 SPO GDN 02.0700 (03/2007) American LegalNet, Inc. www.FormsWorkFlow.com _____________________________________________________________________________ 8. Recommendation as to Appointment of Guardian. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 9. Recommendation Regarding Alleged Incapacitated Person's Right to Vote: _____________________________________________________________________________ 10. Evaluation of Proposed Guardian: A. Dates of Contact Between Guardian ad Litem and Proposed Guardian and Written Materials Reviewed: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ B. Identity and Contact Information Regarding Proposed Guardian: Name: Mailing Address: Street Address (if different from above) Telepho