Fill and Sign the Objecting to Transfer of Form

GN -4370, 04/08 Order on Petitio n Objecting to Transfer of Protective Placement §§55.08, 55.15 , and 55.17, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE MATTER OF Amended Order on Petition Objecting to Transfer of Protective Placement Date of Birth Case No. This m atter is before the court on a Petition Objecting to T ransfer of Protective Placement and a hearing has been held. The court has considered testimony, reports and other evidence present ed , the guardian ad li tem's report and recommendation and other information as follows: THE COURT FINDS: 1. Th e individual who is the subject of this proceeding A. continues to have a primary need for residential care and custody. B. continues to be incompetent, as a result of developmental disability degenerative brain disorder serious and persistent mental illness other like incapacities or is a minor alleged to have a developmental disability and a petition for guardianship has been submitted on the minor’s behalf. C. continues to be so totally incapable of providing for his or her own care or custody as to create a substantial risk of serious harm to himself or herself or others, with serious harm being evidenced by overt acts or acts of omission; and D. continues to have a disability which is permanent o r likely to be permanent. 2. The individual no longer meets the standards for protective placement . 3. The proposed transfer A. meets the standards for transfer because the transfer is to a locked unit and court has made a specific finding as to the need. the individual has a developmental disability and the transfer is to an intermediate facility or nursing facility with the development of a com munity plan or a community plan being furnished to the county department or agency and to the individual’s guardian. the transfer is to the least restrictive environment and in t he least restrictive manner, consistent with the needs of the individual and the resources of the county department, including the limits of available state and federal funds, and county funds required to be appropriated to match state funds. the transfer is to an intermediate facility or nursing facility that is in the most integrated setting that enables an individual to interact with persons without a developmental disability to the fullest extend possible. the transfer is in the best interest of the individual. Other: See attached B. does not meet the standards for transfer because the transfer is to a unit for the acutely mentally ill. the transfer is to a locked unit without a specific finding f rom the court as to the need. the individual has a developmental disability and the transfer is to an intermediate facility or nursing facility without development of a communit y plan or a community plan being furnished to the county department or agency and to the individual’s guardian. the transfer is not to the least restrictive environment and in t he least restrictive manner, consistent with the needs of the individual and the resources of the county department, including the limits of GN -4370 Order on Petition Objecting to Transfer of Protective Placement Page 2 of 2 Case No. GN -4370, 04/08 Order on Petition Objecting to Transfer of Protective Placement §§55.08, 55.15, and 55.17, W isconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 available state and federal funds, and county funds required to be appropriated to match state funds. the transfer is to an intermediate facility or nursing facility that is not in the most integrated setting that enables an individual to interact with persons without a developmental disabil ity to the fullest extend possible. the transfer is not in the best interest of the individual. oth er: See attached 4. The individual meet s the standards for protective services because A. the individual has been determined to be incompetent by circuit court or is a minor who is alleged to be have a developmental disability and on whose behalf a petition for a guardianship has been submitted . B. as a result of a developmental disability , degenerative brain disorder, serious and persistent mental illness, or other like incapacities, the individual will incur a substantial risk of physical harm or deterioration or will present a substantial risk of physical harm to others if protective services are not provided. THE COURT ORDERS: 1. The objection is denied and t he transfer is approved . 2. The objection is granted and t he transfer is prohibite d. 3. The pro tective placement is terminated. A. The individual shall be transferred or discharged from his/her current residential facility within 60 days of this order. The county department shall assist the residential facility with discharge planning for the individual including planning for proper residential living arrangements and the necessary support services for the individual. B. The individual may remain in the current facility which is licensed for fewer than 16 beds. 4. The county department or agency with which it cont racts under §55.02(2), Wis. Stat s., or its designee shall provide protective services to the individual in the least restrictive environment and in the least restrictive manner consistent wi th the needs of the individual and the resources of the county department, including the limits of available state and federal funds, and county funds required to be appropriated to match state funds. 5. Other: THIS IS A FINAL JUDGMENT/ORDER FOR PURPOSES OF APPEAL. DISTRIBUTION: 1. Original - Court 2. Individual 3. Individual ’s Guardian 4. Individual’s Legal Counsel, if any 5. Guardian ad Litem 6. Individual’s age nt under an activated power of attorney for healthcare, if any 7. Facility in which the individual resided when petition for annual review was filed 8. County Department of individual’s coun ty of residence under §55.18(1)(a) 9. County Department of individual’s placement under §55.18(1m) BY THE COURT: Circuit Court Judge/Circuit Court Commissioner Print or Type Name if not eSigned Date