Fill and Sign the Guardianship Minor Colorado Form

 District Court  Denver Probate Court ___________________ County, Colorado Court Address: In the Interest of: Minor COURT USE ONLY Case Number: Division Courtroom LETTERS OF GUARDIANSHIP - MINOR (name of guardian) was appointed or confirmed by the Court on (date) as:  guardian pursuant to §15-14-204, C.R.S. These letters shall expire on _______________, the minor’s 18 th birthday, unless otherwise ordered by the Court.  emergency guardian pursuant to §15-14-204(5), C.R.S. These letters shall expire on _______________ (a date not to exceed 60 days from the date of appointment). The guardian’s powers are specified in the Order.  temporary guardian pursuant to §15-14-204(4), C.R.S. These letters shall expire on ________________ (a date not to exceed six months from the date of appointment). The guardian is authorized to access the minor’s medical records and information. The guardian is deemed to be the minor’s personal representative for all purposes relating to the minor’s protected health information, as provided in HIPAA, Section 45 CFR 164.502(g)(2). These Letters of Guardianship for the minor whose date of birth is , are proof of the guardian’s full authority to act pursuant to §15-14-207, C.R.S., except for the f ollowing restrictions: T he minor’s place of residence shall not be changed from the State of Colorado without an order of the Court pursuant to §15-14-208(2)(b), 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)Clerk of Court JDF 830 R6/13 LETTERS OF GUARDIANSHIP – MINOR © 2013 Colorado Judicial Department for use in the Courts of Colorado