Fillable Report On The Condition And Well-Being Of A Ward (Page 3 of 5) in pdf

A. If there IS a Guardian for the Ward’s Estate, please answer the following questions:

(1) Are you the Guardian of the Ward’s Estate?

Yes (If yes, skip to 9.) No

(2) Does Guardian of the Person receive an allowance from the Guardian of the Estate?

Yes

No

→ If YES, annual amount received ______________________________________________________

B. If there is NOT a Guardian of the Ward’s Estate, please answer the following questions and attach

additional information as directed:

(1) Has a Court Order directed you to manage any funds of the Ward other than Social Security funds?

Yes

No

→ If YES, an Income and Expenses Worksheet must be attached to this Annual Report. The

worksheet can be found on the Fort Bend County website.

(2) Are you the Representative Payee of the Ward’s SSI (Social Security Disability or Social Security

Retirement Benefits)? Yes

No (Name of Rep Payee: _____________________________)

→ If YES, a copy of your most recent Representative Payee Report OR the Court’s Representative

Payee Report Form must be attached to this Annual Report. The Court’s Representative Payee Report

Form can be found on the Fort Bend County website.

9. During the past year the Ward’s physical health has:

Remained about the same.

Improved. Describe __________________________________________________________________

Deteriorated. Describe ________________________________________________________________

10. During the past year the Ward’s mental health has:

Remained about the same.

Improved. Describe __________________________________________________________________

Deteriorated. Describe ________________________________________________________________

HAVE FILED

HAVE NOT FILED for Emergency Detention

11. As Guardian of the Person, I

of the Ward pursuant to the Texas Health & Safety Code. (An example of emergency detention is a request

for an emergency hospitalization of the Ward for mental health or safety reasons.) If you answered HAVE

FILED, please list the number of times and date(s) of each detention. _______________________________

_______________________________________________________________________________________

12. Social Conditions: During the past year, the Ward has participated in the following activities:

(What does the Ward do each day/week? Describe each type of activity checked, e.g., movies, bowling,

Special Olympics, church, eating out, etc. Do not leave blank or only write the name of the residential

facility.)

Recreational _________________________________________________________________________

Educational _________________________________________________________________________

Social ______________________________________________________________________________

Occupational ________________________________________________________________________

None available

Refuses or is unable to participate ________________________________________________________

Page 3of 5

Revised 10-8-15

Report On The Condition And Well-Being Of A Ward Page 3

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