Report On The Condition And Well-Being Of A Ward Page 4
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513. During the past year, Ward has been treated or evaluated by the following professionals: (It is the guardian’s
responsibility to know and provide the information, even if the Ward’s residential facility arranges services.)
Physician Name: ____________________________________ Number of visits this year: __________
General Description of Treatment(s): _________________________________________________________
No
Yes
Does the Ward see this doctor on a regular basis?
Psychiatrist Name: ___________________________________ Number of visits this year: __________
General Description of Treatment(s): _________________________________________________________
Social / Case Worker Name: ___________________________ Number of visits this year: __________
General Description of Treatment(s): _________________________________________________________
Dentist Name: ______________________________________ Number of visits this year: __________
General Description of Treatment(s): _________________________________________________________
Other: Name: _______________________________________ Number of visits this year: __________
General Description of Treatment(s): _________________________________________________________
14. As Guardian, I believe the Ward’s living arrangements are:
Excellent.
Average.
Below average. Describe ______________________________________________________________
_______________________________________________________________________________________
15. As Guardian, I believe that my Ward is:
Content with current living situation.
Unhappy with current living situation. Describe ____________________________________________
_______________________________________________________________________________________
DOES
DOES NOT have unmet needs.
16. As Guardian, I believe my Ward
(Unmet needs = problems with food, shelter, medical care, etc.)
If answered DOES, explain reasons. _________________________________________________________
_______________________________________________________________________________________
17. The power authorized by this guardianship should be:
Unchanged
Decreased
Increased.
If answered Decreased OR Increased, explain reasons. __________________________________________
_______________________________________________________________________________________
18. As Guardian of the Person, I: (check one)
HAVE A CASH BOND ON DEPOSIT WITH THE COURT;
HAVE PAID a bond premium for the next reporting period (attach the paid premium receipt); OR
HAVE NOT PAID a bond premium for the next reporting period.
If answered HAVE NOT PAID, please explain. ________________________________________________
_______________________________________________________________________________________
19. Please state any additional information concerning the Ward which you would like to share with the Court:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Page 4of 5
Revised 10-8-15
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