Annual Report Of Guardian On Condition Of Legally Incapacitated Individual - Michigan Page 2
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34. Physical Health
a. The adult's current physical condition is
excellent.
good.
fair.
poor.
b. During the past year the adult's physical condition has
remained about the same.
improved.
Explain
worsened.
Explain
c. During the past year the adult received the following medical treatment (include check-ups and dental work):
Date
Ailment
Type of Treatment
Doctor’s Name
5. Do-Not-Resuscitate Order
a. I did not execute, reaffirm, or revoke a do-not-resuscitate order.
b. I
executed
reaffirmed
revoked
a do-not-resuscitate order for the adult under MCL 700.5314(d).
In doing so, I
did
did not
consult with the adult and his/her attending physician.
6. Mental Health
a. The adult's current mental condition is
excellent.
good.
fair.
poor.
b. During the past year, the adult's mental condition has
remained about the same.
improved.
Explain
worsened.
Explain
c. During the past year, treatment or evaluation by a psychiatrist, psychologist, or social worker
was
was not
provided.
7. Social Activities/Services
a. The adult's current social condition is
excellent.
good.
fair.
poor.
b. During the past year, the adult's social condition has
remained about the same.
improved.
Explain
worsened.
Explain
c. During the past year, the adult has participated in the following activities:
recreational
educational
social
occupational
No activities were available.
The adult refused to participate in any activities.
The adult was unable to participate in any activities.
(SEE THIRD PAGE)
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