Annual Report Of Personal Needs Guardian - County Of Nassau Supreme Court Page 2
Download a blank fillable Annual Report Of Personal Needs Guardian - County Of Nassau Supreme Court 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 Annual Report Of Personal Needs Guardian - County Of Nassau Supreme Court 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
43.
State the age, date of birth and marital status of the Incapacitated Person.
4. State the present residence address and telephone number of the Incapacitated Person. If said
Incapacitated Person does not presently reside at his or her personal home, set forth the name,
address, and telephone number of the facility or place at which said Incapacitated Person resides, and
the name of the chief executive officer of the facility or the person otherwise responsible for the care
of the Incapacitated Person.
5.
State whether there have been any changes in the physical or mental condition of the Incapacitated
Person, and any substantial change in medication.
6.
State the date and place the Incapacitated Person was last seen by a physician and the purpose of that
visit.
7.
Attach a statement by a physician, psychologist, nurse clinician or social worker, or other person who
has evaluated or examined the Incapacitated Person within the three months prior to the filing of this
report, regarding an evaluation of the Incapacitated Person’s condition and the current functional
level of the Incapacitated Person.
8.
State whether the current residential setting is suitable to the current needs of the Incapacitated
Person and why.
9.
Attach a list of any professional medical treatment given to the Incapacitated Person during the
previous year.
Page 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal