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This is a Wisconsin form that can be used for Guardianship within Statewide, Circuit Court.
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For Official Use STATE OF WISCONSIN, CIRCUIT COURT, Amended COUNTY IN THE MATTER OF Determination and Order on Petition for Guardianship Due to Incompetency Date of Birth Case No. A petition for guardianship due to incompetency was filed and hearing held. After consideration of the reports and other documents on file, all factors required by the statutes and such additional information presented THE COURT FINDS: 1. JURISDICTION, VENUE, NOTICE, APPEARANCES AND EVALUATIONS A. This court does does not have jurisdiction over the subject matter and over 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 because the guardian ad litem waived the individual's attendance. Other: E. The proposed guardian and any proposed stand-by guardian are present as follows: not present and the court permits attendance by telephone for good cause shown as follows: not present and the court excuses the attendance as follows: F. Additional evaluations are not necessary. 2. CAPACITY AND NEED FOR GUARDIANSHIP Upon presentation of clear and convincing evidence, the individual is not incompetent. advanced planning by the individual renders guardianship unnecessary. the elements of the petition are unproven. the application for appointment of a conservator by the proposed ward under §54.76, Wis. Stats. is appropriate. the individual was adjudicated incompetent in another jurisdiction and a petition for receipt and acceptance of a foreign guardianship was granted. the individual is a minor who has attained age 14 and is developmentally disabled. the individual is found to be incompetent as a result of: a developmental disability degenerative brain disorder serious and persistent mental illness other like incapacities based upon the following standards: A. The individual is at least 17 years and 9 months of age. B. The individual's need for assistance in decision-making or communication is unable to be met effectively and less restrictively through appropriate and reasonably available training, education, support services, health care, assistive devices, or other means that the individual will accept. C. (For appointment of guardian of the person) The individual, because of impairment, is unable effectively to receive and evaluate information or to make or communicate decisions to such extent that the individual is unable to meet the essential requirements for the individual's physical health and safety. GN-3170, 02/16 Determination and Order on Petition for Guardianship Due to Incompetency Page 1 of 6 §54.10(3), 54.74, Chapter 46 and 54, Wisconsin Statutes American LegalNet, Inc. www.FormsWorkFlow.com This form shall not be modified. It may be supplemented with additional material. Determination and Order on Petition for Guardianship Due to Incompetency Page 2 of 6 Case No. __________ D. (For appointment of guardian of the estate) The individual, because of an impairment, is unable effectively to receive and evaluate information or to make or communicate decisions related to management of the individual's property or financial affairs, to the extent that at least one of the following applies: (1) The individual has property that will be dissipated in whole or in part; or (2) The individual is unable to provide for the individual's support; or (3) The individual is unable to prevent financial exploitation. 3. GUARDIAN OF THE PERSON The individual is in need of a guardian of the person. A. Rights to be removed in full. If removed, these rights may not be exercised by any person. The individual has incapacity to exercise the following rights: (1) execute a will. (2) serve on a jury. (3) register to vote or to vote in an election. B. Rights to be removed in full or exercised by individual only with consent of Guardian of Person. The individual has incapacity to exercise the following rights: Ward may not exercise this right. Remove right in full. Ward may exercise only with the consent of the Guardian of the Person. (1) consent to marriage. (2) apply for an operator's/driver's license. (3) apply for a fishing license. (4) apply for a license under Ch. 29, Wis. Stats., other than fishing. (5) apply for a credential under §440.01(2), Wis. Stats. (6) consent to sterilization. (7) consent to organ, tissue, or bone marrow donation. C. Powers to be transferred to Guardian of the Person in part or in full. The court transfers to the Guardian of the Person: 1.A. The power to give an informed consent to the voluntary receipt by the ward of a medical examination, medication, including any appropriate psychotropic medication, and medical treatment that is in the ward's best interest, if the guardian has first made a good-faith attempt to discuss with the ward the voluntary receipt of the examination, medication, or treatment and if the ward does not protest. Full Transfer. Partial Transfer. The individual retains the power to: 1.B. The power to give informed consent, if in the ward's best interests, to the involuntary administration of a medical examination, medication other than psychotropic medication, and medical treatment that is in the ward's best interest. Full Transfer. Partial Transfer. The individual retains the power to: 2. The power to authorize individual's participation in an accredited or certified research project if the research project might help the individual, or others if minimal risk of harm. Full Transfer. Partial Transfer. The individual retains the power to: The power to authorize individual's participation in research that might not help the individual but might help others if greater than minimal risk of harm to the individual but evidence indicates individual would have elected to participate. Full Transfer. Partial Transfer. The individual retains the power to: The power to consent to experimental treatment in the individual's best interests. Full Transfer. 5. 6. Full Transfer. Partial Transfer. The individual retains the power to: Partial Transfer. The individual retains the power to: The power to give informed consent to receipt by individual of social and supported living services. The power to give informed consent to release of confidential records other than court, treatment, and patient health care records and redisclosure as appropriate. Full Transfer. 7. Partial Transfer. The individual retains the power to: The power to make decisions related to mobility and travel. §54.10(3), 54.74, Ch
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