Provisional Letters Pursuant To

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District Court
Denver Probate Court
___________________ County, Colorado
Court Address:
In the Interest of:
COURT USE ONLY
Case Number:
Ward/Protected Person
Division _____ Courtroom ______
PROVISIONAL LETTERS PURSUANT TO §15-14.5-302, C.R.S.
(Name) was appointed or qualified by this Court
with an order for provisional appointment on
(date) as:
Conservator. These are Letters of Conservatorship
Guardian. These are Letters of Guardianship for an incapacitated person.
These Provisional Letters are proof of the Guardian’s/Conservator’s authority to act and shall
expire 60 days from issuance, unless extended by order of the Court with the following limitations.
The Guardian shall have access to Ward’s medical records and information to the same extent that the
Ward is entitled. The Guardian shall be deemed to be Ward’s personal representative for all purposes
relating to Ward’s protected health information, as provided in HIPAA, Section 45 CFR 164.502(g)(2).
The Guardian does not have the authority to obtain hospital or institutional care and treatment for
mental illness, developmental disability or alcoholism against the will of the Ward pursuant to §15-14-
316(4), C.R.S.
Other limitations:
Date: _____________________________
___________________________________
Probate Registrar/(Deputy)Clerk of Court
CERTIFICATION
Certified to be a true copy of the original in my custody and to be in full force and effect as of
_____________________ (date).
Probate Registrar/(Deputy
of Court
JDF 781
9/08
PROVISIONAL LETTERS PURSUANT TO §15-14.5-302, C.R.S

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