Conservatorship Care Plan
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NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT
STATE BAR NUMBER
ATTORNEY:
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES
Name of Court:
Branch Name:
Street Address:
City and Zip Code:
In the Matter of:
CASE NUMBER:
CONSERVATORSHIP CARE PLAN
, the conservator of the person/estate of
hereby submits the conservator’s General Plan in compliance with local court rules.
1. Conservatee’s current residence address:*
a Type of facility (i.e. home, skilled nursing, hospital, etc.)
b. How long has the conservatee been in the present residence?
c. Do you anticipate making any changes in the conservatee’s residence in the next
year?
No
Yes (explain)
d. What is the plan to return the conservatee to his/her personal residence if not now
living at home?
e.
If there are no plans to return the conservatee to his/her personal residence in the
foreseeable future, explain the limitations or restrictions for not doing so?
2. Current level of care (mark all that apply):
requires total care
has feeding tube
requires assistance with care
has a catheter
able to do own care
uses wheelchair/walker
ambulatory
urinary/bowel incontinence
Other relevant information
If residing in a facility or group home, attach copy of the facility’s care plan:
If client of a regional center, identify regional center and social worker and telephone
number:
*Please note that the Probate Investigator’s Office must be notified of any change of
address by using the Notification to Court of Address form number PRO 003.
PRO-023
Conservatorship Care Plan
PC Section 2352.5 (c)
ADMIN Approved (Rev. 07/08)
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Parent category: Medical