Order On Petition For Modification Of Order For Protective Placement Or Protective Services {GN-4400} | Pdf Fpdf Doc Docx | Wisconsin

Order On Petition For Modification Of Order For Protective Placement Or Protective Services {GN-4400}

Wisconsin/Statewide/Circuit Court/Guardianship/
Order On Petition For Modification Of Order For Protective Placement Or Protective Services {GN-4400} | Pdf Fpdf Doc Docx | Wisconsin

Order On Petition For Modification Of Order For Protective Placement Or Protective Services Form

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This is a Wisconsin form that can be used for Guardianship within Statewide, Circuit Court.

Last updated: 4/24/2007
FORM SUMMARY Name of Form Order on Petition for Modification of Protective Placement or Protective Services (Other than Psychotropic Medication) GN-4400 Form Number Statutory Reference: Benchbook Reference: Purpose of Form: §§46.279(2) and 55.16, Wisconsin Statutes Court order on Petition for Modification of Protective Placement or Protective Services (Other than Psychotropic Medication) Petitioner or attorney Original to Court, copies to interested parties. Who Completes It: Distribution of Form: Accompanying Forms: New Form/Modification: Modifications: New Form. Developed to comply with 2005 Wis. Acts 264, 387 and 388. About this Form: This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Date: 01/26/07 Page 1 American LegalNet, Inc. www.FormsWorkflow.com For Official Use STATE OF WISCONSIN, CIRCUIT COURT, Amended COUNTY IN THE MATTER OF Order on Petition for Modification of Protective Placement or Protective Services (Other than Psychotropic Medication) Case No. Date of Birth This matter is before the court on a petition for modification of an order for protective placement. protective services (other than an order for involuntary administration of psychotropic medication). A hearing has not been held within the previous 6 months on court-ordered protective placement, court-ordered protective services or transfer of protective placement. A hearing has been held on the petition for modification of protective placement or protective services within 21 days after filing the petition, unless the individual, individual's guardian, guardian ad litem, or attorney has requested an extension. Based on the testimony, reports, community plan (if applicable), other evidence presented, the report and recommendation of the guardian ad litem. THE COURT FINDS: 1. NOTICE AND JURISDICTION A. Notice was properly served. B. This court has jurisdiction of the subject matter and of the person of the individual. 2. PROTECTIVE PLACEMENT A. Continuation: The individual continues to meet the standards for protective placement under §55.08 (1) and the individual's protective placement is in the least restrictive environment and least restrictive manner consistent with the requirements of §55.12 (3), (4), and (5), and protective placement is in the most integrated setting if the individual has a developmental disability and placement is in a nursing facility or intermediate care facility. B. Modification: The individual continues to meet the standards for protective placement under §55.08 (1), but the protective placement is not in the least restrictive environment that is consistent with the requirements of §55.12 (3), (4), and (5), or protective placement is not in the most integrated setting if the individual has a developmental disability and placement is in a nursing facility or intermediate care facility. C. Termination: The individual no longer meets the standards for protective placement under §55.08 (1). The individual needs protective services and meets the standards for protective services as follows: GN-4400, 01/07 Order on Petition for Modification of Order for Protective Placement or Protective Services Page 1 of 3 §§46.279 (2) and 55.16, Wisconsin Statutes American LegalNet, Inc. www.FormsWorkflow.com This form shall not be modified. It may be supplemented with additional material. Order on Petition for Modification of Order for Protective Placement or Protective Services Page 2 of 3 Case No. (1) The individual has been determined to be incompetent by a circuit court or is a minor who is alleged to be developmentally disabled and on whose behalf a petition for guardianship has been submitted; and (2) As a result of developmental disabilities, degenerative brain disorder, serious and persistent mental illness, or other like incapacities, the individual will incur a substantial risk of physical harm or deterioration or will present a substantial risk of harm to others if protective services are not provided. 3. PROTECTIVE SERVICES (Other than order for involuntary administration of psychotropic medication) A. Continuation: The individual continues to meet the standards for protective services under §55.08 (2) and the current protective services are provided in the least restrictive manner that is consistent with the requirements of §55.12 (3), (4), and (5). B. Modification: The individual continues to meet the standards for protective services under §55.08 (2), but the protective services for the individual are not provided in the least restrictive manner that is consistent with the requirements of §55.12 (3), (4), and (5). C. Termination: The individual no longer meets the standards for protective services under §55.08 (2). THE COURT ORDERS: 1. PROTECTIVE PLACEMENT: A. Continuation: Protective placement is continued in the facility in which the individual resides at the time of the hearing. B. Modification: Transfer of the individual to a protective placement that is in the least restrictive environment consistent with the requirements of §55.12 (3), (4), and (5), and; to the following specific facility: that the county department of the individual's residence develop or recommend a protective placement that is in the least restrictive environment consistent with the requirements of §55.12 (3), (4), and (5), and arrange for the individual's transfer to that protective placement within 60 days of the date of this order. This time period is extended to permit development of a protective placement as follows: protective services along with the transfer of protective placement. C. Termination: The protective placement is terminated. 1. The individual shall be transferred or discharged from his/her current residential facility within 60 days of this order. The county department shall assist the residential facility with discharge planning for the individual including planning for proper residential living arrangements and the necessary support services for the individual. 2. The individual may remain in the current facility, which is licensed for fewer than 16 beds. 3. The county department or agency with which is contracts under §55.02(2), Wisconsin Statutes, or its designee shall provide protective services to the individua