Statement Of Expert Evaluation Page 3
Download a blank fillable Statement Of Expert Evaluation in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Statement Of Expert Evaluation with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4CASE NO. ___________________________
8.
Is the individual physically impaired?
Yes
No
If yes: Description
___________________________________________________________________________________________
9.
Are there any special characteristics of the individual which should be considered in evaluating the individual for
guardianship:
Yes
No
If yes: Explain
___________________________________________________________________________________________
___________________________________________________________________________________________
10.
Are there any indication of abuse, neglect or exploitation of the individual?
Yes
No
If yes: Explain _______________________________________________________________________________
___________________________________________________________________________________________
11.
Do you believe the individual is capable of caring for the individual’s activities of daily living or making decisions
concerning medical treatments, living arrangements and diet?
Yes
No
If no: Explain ________________________________________________________________________________
12.
Do you believe this individual is capable of managing the individual’s finances and property?
Yes
No
If no: Explain
___________________________________________________________________________________________
13.
Prognosis:
A.
Is the condition stabilized?
Yes
No
B.
Is the condition reversible:
Yes
No
14.
In my opinion a guardianship should be:
Established/Continued
Denied/Terminated
I certify that I have evaluated the individual on ________________________________________________, 20 _________
Date: _____________________________________
_______________________________________________
Signature of Evaluator
GUARDIAN’S REPORT ADDENDUM
(Not to be used with initial Application)
It is my opinion, based upon a reasonable degree of medical or psychological certainty, that the mental capacity of
this ward will no improve.
___________________________________
________________________________________
Date
Signature – Licensed Physician/Clinical Psychologist
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business