Fill and Sign the Order Appointing Guardian Form

JDF 828 R6/13 ORDER APPOINTING TEMPORARY GUARDIAN FOR MINOR Page 1 of 2  District Court  Denver Probate Court _________________________________ County, Colorado Court Ad dress: In the Interests of: Minor COURT USE ONLY Case Number: Division Courtroom ORDER APPOINTING TEMPORARY GUARDIAN FOR MINOR PURSUANT TO §15 -14 -204(4), C.R.S. Upon consideration of the Petition for Appointment of Temporary Guardian for the above minor and/or hearing on ________________________ (date), The Court finds, determines and orders: 1. Venue is proper and required notices have been given or waived. 2. The minor was born on (date). 3. A qualified person seeks appointment. 4. An immediate need exists for the appointment of a temporary guardian and the appointment would be in the best interest of the minor. 5. The temporary guardianship can not exceed six months from appointment. 6. The Court appoints the following person as temporary guardian for the minor: Name: _________________________________________________________________________________ Street Address: __________________________________________________________________________ City: ___________________ State: ___ Zip Code: ________ Primary Phone #: _______________________ Mailing Address, if different:_____________________________________ ___________________________ Email Address: _________________________________ Alternate Phone #: ______________________ 7. The guardian shall promptly notify the Court if the guardian’s home address, email address, or phone number changes and/or of any ch ange of address for the minor. 8. The guardian may not establish or move the minor’s custodial dwelling outside the State of Colorado without a Court order. 9. Copies of all future Court filings shall be provided to the following interested persons: Name Relationship to Minor Minor if 12 years or older at time of JDF 828 R6/13 ORDER APPOINTING TEMPORARY GUARDIAN FOR MINOR Page 2 of 2 mailing Parent or adult nearest in kinship Parent or adult nearest in kinship 10. The guardian shall provide a copy of this Order Appointing Temporary Guardian for Minor to the minor (if 12 years of age or older) and interested persons within five days after the appointment pursuant to §15 -14 -204(4), C.R.S. 11. The temporary guardian is authorized to access the minor’s medical records and information. The temporary guardian is deemed to be the minor’s personal representative for all purposes relating to the minor’s protected health information, as provided in HIP AA, Section 45 CFR 164.502(g)(2). 12. Letters of temporary guardianship shall be issued. This temporary guardianship expires on _____________________ (date not to exceed six months from appointment.)  The powers and duties of the temporary guardian are unrestricted.  The powers and duties of the temporary guardian are limited by the following restrictions: __________________________________________________________________________________ _____________ _____________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ ___________________ _______________________________________________________________ 13. The Court further orders: __________________________________________________________________________________ __________________________________________________________________________ ________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ Date: __________________________ ______________________________________  Judge  Magistrate