Indiana Guardianship Form E-13 - Physician'S Report (Page 2 of 3) in pdf

Indiana Guardianship Form E-13 - Physician'S Report Page 2

In your opinion, is the Patient totally or only partially incapable of making personal and financial

decisions; and, if the latter, the kinds of decisions which the Patient can and cannot make.

(Include the reason for this opinion.)

In your opinion, what is the most appropriate living arrangement for the Patient; and, if applicable,

describe the most appropriate treatment or rehabilitation plan. (Include the reason for this

opinion.)

Can the Patient appear in Court without injury to his/her health?

[ ] Yes

[ ] No

If the answer is no, explain the medical reasons for your answers.

Is the Patient capable of consenting to the appointment of a Guardian?

[ ] Yes

[ ] No

Is the nature of the Patient’s incapacity such that it prevents the Patient from making a knowing

and voluntary Waiver of Notice?

[ ] Yes

[ ] No

10.

In your opinion, is a Guardian needed to care for the Patient

[ ] Yes

[ ] No

11.

If a Guardian is needed, is one needed for personal or financial need, or both?

[ ] Personal

[ ] Financial

Indiana Guardianship Form E-13 - Physician'S Report Page 2