Fill and Sign the 2017 2019 Form Mi Pc 562 Fill Online Printable Fillable

In the matter of First, middle, and last name , a legally incapacitated individual STATE OF MICHIGAN PROBATE COURT COUNTY OF ANNUAL REPORT OF GUARDIAN ON CONDITION OF LEGALLY INCAPACITATED INDIVIDUAL FINAL REPORT FILE NO. 1. I, Name (type or print) , am the guardian of the adult named above and my annual report for the period of Date to Date is as follows. 2. Present age of the adult: Date of birth: 3. Living Arrangement a. The current address and telephone number of the adult are: b. The name of the facility where the adult resides, if any: Check here if this is a new address c. The adult's residence is: \ own home/apartment guardian's home/apartment other: (boarding home, assisted living, etc.) nursing home hospital or medical facility foster home relative's home: Relationship d. The adult has been in the present residence since Date . If moved within the past year, state the changes and the reasons for change. e. I rate the adult's living arrangement as excellent. average. below average. Explain f. I believe the adult is content with the living situation. unhappy with the living situation. g. I recommend a more suitable living arrangement for the adult as follows:\ Approved, SCAO Do not write below this line - For court use only (SEE SECOND PAGE) USE NOTE: If this form is being filed in the circuit court family division, please\ enter the court name and county in the upper left-hand corner of the fo\ rm. PC 634 (2/18) ANNUAL REPORT OF GUARDIAN ON CONDITION OF LEGALLY INCAPACITATED INDIVIDUAL MCL 700.5314(e), (g), MCL 700.5317, MCR 5.409(A) NOTE: This report must be completed yearly by the guardian, or more often if d\ irected by the court. The guardian must serve the completed report on the ward and all interested persons as required \ by Michigan Court Rules 5.105 and 5.125. Then the guardian must complete a proof of service (form PC 564) and f\ ile it and this report with the court. PCS CODE: AGW TCS CODE: AGW File No. 4. Physical Health a. The adult's current physical condition is excellent. good. fair. poor. b. During the past year the adult's physical condition has remained about the same. improved. Explain worsened. Explain c. During the past year the adult received the following medical treatment \ (include check-ups and dental work): Date Ailment Type of Treatment Doctor’s Name 5. Do-Not-Resuscitate Order a. I did not execute, reaffirm, or revoke a do-not-resuscitate order. b. I executed reaffirmed revoked a do-not-resuscitate order for the adult under MCL 700.5314(d). In doing so, I did did not consult with the adult and his/her attending physician. 6. Physician Orders for Scope of Treatment (POST) Form a. I did not execute, reaffirm, or revoke a POST form. b. I executed reaffirmed revoked a POST form for the adult under MCL 700.5314(f). In doing so, I did did not consult with the adult and his/her attending physician. 7. Mental Health a. The adult's current mental condition is excellent. good. fair. poor. b. During the past year, the adult's mental condition has remained about the same. improved. Explain worsened. Explain c. During the past year, treatment or evaluation by a psychiatrist, psychologist, or social wor\ ker was was not provided. 8. Social Activities/Services a. The adult's current social condition is excellent. good. fair. poor. b. During the past year, the adult's social condition has remained about the same. improved. Explain worsened. Explain (SEE THIRD PAGE) Annual Report of Guardian on Condition of Legally Incapacitated Individu\ al (2/18) File No. 8. (continued) c. During the past year, the adult has participated in the following activities: recreational educational social occupational No activities were available. The adult refused to participate in any activities. The adult was unable to participate in any activities. 9. List of Visits a. During the past year, I visited the adult as follows: List dates b. The average amount of time I spent on each visit was . c. The last time I visited with the adult was on Date . 10. Activities During the past year, I performed the following activities on behalf of the adult: 11. Consultation During the past year, I consulted with the adult before making the following decisions: 12. I believe the adult has the following unmet needs: 13. The guardianship should should not be continued because: Note: If you no longer wish to serve as guardian, you must file a petition to \ remove yourself. 14. There is is not more cash or property than what was previously reported to the court. If there is, specify the additional amount: $ . 15. As guardian, I have been ordered by the court to file an annual account,\ which is attached. Date Date Signature of guardian Signature of co-guardian (if applicable) Address Address City, state, zip \ Telephone no. City, state, zip \ Telephone no. Check here if this is a new address Check here if this is a new address Annual Report of Guardian on Condition of Legally Incapacitated Individu\ al (2/18)