Statement Of Expert Evaluation {17.1} | Pdf Fpdf Doc Docx | Ohio

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Statement Of Expert Evaluation {17.1} | Pdf Fpdf Doc Docx | Ohio

Statement Of Expert Evaluation {17.1}

This is a Ohio form that can be used for Guardianship within County (Court Of Common Pleas), Stark, Probate.

Alternate TextLast updated: 7/24/2007

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<document>COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.PROBATE COURT OF STARK COUNTY, OHIOJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)GUARDIANSHIP OFCASE NO.STATEMENT OF EXPERT EVALUATION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Definition of Incompetent (R.C. 21 11.01(D)): "Incompetent means any person who is so mentally impaired as a result of a physical or mental illness or disability, or retardation, or as a result of chronic substance abuse, that he is incapable of taking proper care of himself or his property or fails to provide for his family or other persons for whom he is charged by law to provide, or any person confined to a penal institution within this State."THE PEOPLE OF THE STATE OF NEW YORK TOThe Statement of Evaluation does not declare the prospective ward competent or incompetent, but is evidence to be considered by the Court.The fee for completing this evaluation WILL NOT be paid by the Court. Each evaluator should secure payment from the Applicant/Guardian.GREETINGS:1.This Statement of Evaluation is for:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomGuardianship Application. (To be completed by a Licensed Physician or Licensed Clinical Psychologist, and attached to the Application.) Guardian's Report. (Evaluation and Statement by a Licensed Physician, Licensed Clinical Psychologist, Licensed Social Worker, or Mental Retardation Team to be completed within three months of date of the report. R.C. 21 11.49(A)(1)(l).)2.Statement completed by: (please type or print)NameYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.AddressPhoneLicensed PhysicianLicensed Clinical Psychologist, one of the Justices of theLicensed Social WorkerMental Retardation TeamCourt in Witness, Honorableday of, 20 County,3.Following is my diagnosis/assessment of the mental and physical capacity, and the functioning level of the prospective ward.(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:4.Is the prospective ward mentally impaired?YesNo -Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comFORM 17.1 STATEMENT OF EXPERT EVALUATIONCOUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.5.A. Is there observed or reported evidence of mental impairment?YesNoDescribe:JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)B. If reported, name source:If the prospective ward is mentally impaired, what is the cause? 6.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7.A. Is there observed or reported evidence of physical impairment?THE PEOPLE OF THE STATE OF NEW YORK TOYesNo -Describe:B. If reported, name source:GREETINGS:Can the prospective ward conduct business affairs without the aid of a guardian?WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableYesNo -Comments: 8.,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in room9.Can the prospective ward properly care for himself without the aid of a guardian?YesNoComments:Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.10.(TO BE COMPLETED IF SUBMITTED WITH A GUARDIAN'S REPORT)In my opinion, the guardianship should be: ContinuedTerminated., one of the Justices of the(TO BE COMPLETED IF SUBMITTED WITH AN APPLICATION FOR GUARDIANSHIP)11.Court in Witness, Honorableday of, 20 County,In my opinion, the application for guardianship: Should be grantedShould not be granted.ADDITIONAL COMMENTS(Attorney must sign above and type name below)Attorney(s) forOffice and P.O. AddressI certify that I have evaluatedfor the purpose of guardianship.Telephone No.: Facsimile No.: E-Mail Address:Dated of EvaluationEvaluatorMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com</document>

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