Rc Form 17.66g - Application Of Guardian To Provide Direct Services To Ward

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PROBATE COURT OF RICHLAND COUNTY, OHIO
GUARDIANSHIP OF
CASE NO.
APPLICATION OF GUARDIAN TO PROVIDE
DIRECT SERVICES TO WARD
[Sup.R. 66.01 (B), 66.04 (D), and 66.09 (G)]
“Direct Services” are defined in Sup.R. 66.01 (B) as services typically provided by home
and community based and institutionally based care providers, including medical and
nursing care or case management services, care coordination, speech, occupational and
physical therapy, psychological services, counseling, residential, legal representation, job
training and any other similar services. Sup.R. 66.09 (G) prohibits “Direct Services” by a
guardian to a ward, unless otherwise approved by the Court and Sup.R. 66.04 (D)
prohibits the appointment of a direct services provider as guardian for a ward to whom
the provider delivers direct services unless otherwise authorized by law.
Check all that are applicable (Attach additional pages, if necessary)
1. The Guardian of the ward named above applies to the Court for authority to
provide direct services to the ward.
2. The Guardian of the ward named above applies to the Court for approval of the
guardian receiving from a third party compensation for direct services to be
provided to the ward by the Guardian. The Guardian is not an employee of the
payer.
3. The Guardian represents to the Court that it is in the wards best interests of the
Ward that this application be approved because:
4. Compensation for these services is being paid to the Guardian by:
5. The direct services being provided are:
A. Personal care to a child of the guardian in the guardian’s residence
that may involve personal hygiene, feeding, medicating, and/or
dressing of the Ward.
B. Other:
Clear Form
RC FORM 17.66G – APPLICATION OF GUARDIAN TO PROVIDE DIRECT SERVICES TO WARD

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