Annual Report Of Personal Needs Guardian - County Of Nassau Supreme Court (Page 3 of 4) in pdf

Annual Report Of Personal Needs Guardian - County Of Nassau Supreme Court Page 3

10. State the plan for medical, dental and mental health treatment and related services for the coming

year

11. State any other information concerning the social condition of the Incapacitated Person, including the

social and personal services currently utilized by the Incapacitated Person, the social skills of the

Incapacitated Person and the social needs of the Incapacitated Person. List the number of times that

you have visited the Incapacitated Person during the past year.

12. Attach a list of any other pertinent facts relative to the care and maintenance of the Incapacitated

Person, including the frequency of your visits; whether the Incapacitated Person has made a Will or

executed a Power of Attorney; and any other information necessary for the proper administration of

this matter.

STATE OF

)

ss:

COUNTY OF

)

I/We, __________________________ and ______________________________, being duly sworn say:

I am/We are the Guardian(s) for the above-named Incapacitated Person. The foregoing report is to the

best of my knowledge a true and complete statement of the information presented therein. I/We do not

know of any error or omission in this Report to the prejudice of said Incapacitated Person.

______________________________________

____________________________________

Guardian

Sworn to before me this

_____ day of _________________, 20__.

_________________________________

Notary Public

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Annual Report Of Personal Needs Guardian - County Of Nassau Supreme Court Page 3