ࡱ > G I F bjbj
.6 h h + + + + $ O L + - v v v $ % ! z v v z z \ \ \ z
\ z \ \ : P , s){y + F |
0 - R I" I" I" v v T \ @ D v v v R
v v v - z z z z I" v v v v v v v v v : IN THE CIRCUIT COURT
FOR ORANGE COUNTY, FLORIDA
PROBATE DIVISION
IN RE: GUARDIAN ADVOCATE OF
_______________________________________
Case No: _____________________
ANNUAL GUARDIAN ADVOCATE REPORT
ANNUAL GUARDIAN ADVOCATE PLAN OF GUARDIAN OF PERSON
FORM S
I, __________________________________________________________________, the
Guardian Advocate of the person of
____________________________________________________________ submits the
following plan as the Annual Guardianship Report of this guardian:
The Annual Guardianship Plan for the period beginning __________________________,
and ending _____________________________________, shall be as follows:
The Wards address at the time of filing this plan is
__________________________________________________________________
__________________________________________________________________
2. During the preceding year, the Ward resided at (include dates, names, addresses and length of stay at each place):
3. The current residential setting (circle on) is or is not best suited for the current needs of the Ward.
4. Plans for ensuring that the Ward is in the best residential setting to meet the Wards needs during the coming year are as follows:
5. Description of professional medical treatment given to the Ward during the preceding year:
PHYSICIAN TREATMENT DATE
6. Report of a physician who examined the Ward no more than 90 days before the beginning of the report period is attached. Report contains an evaluation of the Wards condition and a statement of the current level of capacity of the Ward.
7. Plan for provision of medical, mental health and rehabilitative services in the coming year is as follows:
8. Information concerning the social condition of the Ward is submitted as follows:
A. The social and personal services currently utilized by the Ward are:
B. State the social skills of the Ward, including how well the Ward maintains interpersonal relationships with others:
C. Describe the Wards activities at communication and visitation:
D. Description of the social needs of the Ward:
9. Summary of activities during the preceding year designed to increase the capacity of the Ward:
10. The Ward (circle one that applies) is or is not capable of having some or all of
his/her rights restored. If capable, identify rights that should be restored
11. I/We (circle one) do or do not plan to seek the restoration of any rights to the Ward.
12. This plan (circle one) has or has not been reviewed with the Ward to the extent possible.
Under penalties of perjury, I declare that I have read the foregoing, and the facts alleged are true, to the best of my knowledge and belief.
Signed on the ______ day of ____________________________
_____________________________________________________________
Attorney for Guardian (If applicable)
Florida Bar No.________________________________________________
_____________________________________________________________
Signature of Guardian
_____________________________________________________________
Signature of Co-Guardian
_____________________________________________________________
Address
_____________________________________________________________
Signature of Ward (If applicable)
IN THE CIRCUIT COURT FOR ORANGE COUNTY, FLORIDA
PROBATE DIVISION
IN RE: GUARDIAN ADVOCATE OF
__________________________________
CASE NO.
PHYSICIANS REPORT
Name of Physician: __________________________________________
Address: ______________________________________________
________________________________________________________
2. Name of ward: _______________________________________________
3. Date of examination: __________________________________________
4. Purpose of examination:
a. Regular checkup _____________________________________
b. Treatment for _______________________________________
5. Evaluation of wards condition: (Specify mental and physical condition at time of exam)
________________________________________________________________________
________________________________________________________________________
6. Description of wards capacity to live independently:
________________________________________________________________________
________________________________________________________________________
7. The ward (circle one) does or does not continue to need assistance of a guardian.
8. Is the ward capable of being restored to capacity at this time? (circle one) Yes or NO
9. Date of this report: ____________________
10. Signature of physician completing this report: _______________________________
8 A 6 H W X | }
'
(
,
-
0
1
4
5
;
<
E
M
c
d
* + - T o u hA( hL6x hi{e hL! h8C h ] h ] hL6x h .O h ] hL6x hL h ] hu_ CJ aJ hL6x h 5hL6x h
5hL6x h@} 5hL6x hu_ 5h97 hL6x hu_ > 1 B C _ ` a
W X | }
c
gd ] $a$gdu_ $a$gdu_ gdu_ c
d
* + p q ^ $0^`0a$gdu_ $a$gdL! $a$gd .O $^a$gd .O $
& F a$gd .O gdu_ $a$gdu_ ! $ ' . V W Q
Z
[
g h R Y & ) , 3 U W # ' * 2 U X j l 5 6 8 < [ o u v h hL6x h|? hN h6\ hL6x h hL6x h haC hL6x haC h hL6x h, hL6x hl h O hL6x hu_ 5\ hL6x hu_ C^ P
Q
R
S
T
U
V
W
X
Y
Z
[
u
0^`0gdu_ gdu_ $0^`0a$gdl u
v
f g h 5 6 ^`gdu_ 0^`0gdu_ 0^`0gd gdu_
P Q R S T U V W X Y ^`gdu_ ^`gd gdu_ U j k l 0^`0gdu_ gdu_ 6 7 8 v 4 5 6 t 9 j | gd+ $a$gd# gd gd gdu_ 5 s t ) * 8 9 i j | & + [ 3 S ;ͭ뭢뢗듗 h h hL6x hII ht @ hII hII hII h# h# 5 h d 5h+ hL6x h97 h97 h# hL6x hSz hH hL6x h h h hL6x hu_ hL6x h|? hL6x h 9 [ T U q r ^`gdu_ gdu_ $a$gd+ $a$gdu_
& F gdII $a$gd# $a$gd# gd+ S T U C D E F E F K Q U X [ \ ] n ƿʸԴ hqt hu_ 5\ hL6x h h hL6x hu_ 5\ h+ hL6x h+ h+ hu_ CJ aJ hL6x h hL6x hu_ h hu_ / E F ^ _ \ ] gd gdu_ , 1h / =!"#$% ^ 2 0 @ P ` p 2 ( 0 @ P ` p 0 @ P ` p 0 @ P ` p 0 @ P ` p 0 @ P ` p 0 @ P ` p 8 X V ~ _HmH nH sH tH @ ` @ ] N o r m a l CJ _HaJ mH sH tH D A D D e f a u l t P a r a g r a p h F o n t R i R T a b l e N o r m a l 4
l 4 a ( k ( N o L i s t V o V u_ D e f a u l t 7$ 8$ H$ ! B*CJ _HaJ mH ph sH tH PK ! [Content_Types].xmlj0Eжr(Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi} ;~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭? PK ! ֧ 6 _rels/.relsj0 }Q%v/C/} (h"O
= C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_ 6LR7`0̞O,En7Lib/Se е PK ! ky theme/theme/themeManager.xml M
@}w7c(Ebˮ CAǠҟ7՛K
Y,
e.|,H ,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+&
8 PK ! P theme/theme/theme1.xmlYOo6w toc'vuر-Mn iP@I}úama[إ4:l ЯGRX^6؊>$ !)O^rC$y@ /yH*)UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSe bORD۫qu gZo~ٺlAplxpT0+[}`j zA V2Fi@qv֬5\|ʜ̭NleXd sjcs7f
W+Ն7` g ȘJj|h(KD-
dXiJ؇(x$( :;˹! I_TS 1?E ??ZBΪmU/ ?~xY'y5g&/ɋ>GMGeD3Vq%'#q$8K )fw 9:ĵ
x}rxwr:\TZaG*y8IjbRc|XŻǿI
u3KGnD 1NIBs
RuK>V.E L+M2#'fi ~V vl{u8z H
* :( W ☕
~JTe\O*tHGHY }KNP*ݾ˦ TѼ9/#A7qZ $*c?qUnwN%Oi4 =3ڗP
1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g-
eW
)6-rC Sj
id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q% p%m&]caS l=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f
Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ .uχYC6OMf3or$5N HT[XF64T,ќM0E)`#5XY`פ ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R 3U~7+#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vp IYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07% < ҍ PK !
ѐ ' theme/theme/_rels/themeManager.xml.relsM
0wooӺ&݈Э5
6?$Q
,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{ P8g/ ]QAsم(#L[ PK- ! [Content_Types].xmlPK- ! ֧ 6 + _rels/.relsPK- ! ky theme/theme/themeManager.xmlPK- ! P theme/theme/theme1.xmlPK- !
ѐ ' theme/theme/_rels/themeManager.xml.relsPK ]
6 S c
^ u
8 @ 0 (
B
S ? { 81 { R1 { L61 { 4E1 { D71 { R1 { d# { 4S1 ( H
H
a
& / / _
h
h
9 *urn:schemas-microsoft-com:office:smarttagsplace 8 *urn:schemas-microsoft-com:office:smarttagsCity 9 *urn:schemas-microsoft-com:office:smarttagsState S d g W [ E K 3 3 3 3 3 + - k o
R S E F K 2&0'7$ $^x| 8 8^8`o( .
^`h H .
L ^ `Lh H .
^ `h H .
x x^x`h H .
HL H^H`Lh H .
^`h H .
^`h H .
L ^`Lh H . ^`o( .
t t^t`h H .
DL D^D`Lh H .
^
`h H .
^ `h H .
L ^`Lh H .
^`h H .
T T^T`h H .
$L $^$`Lh H . 2&0' $^ =r `L
o * ) aC O L! * , 97 19 t @ a@ 8C II M .O ] u_ i{e C o m p O b j y
F' Microsoft Office Word 97-2003 Document
MSWordDoc Word.Document.8 9q