Fill and Sign the Report Conservatorship Form

 District Court __________________________________ County, Colorado Court Address: In the Interest of: Respondent COURT USE ONLY Court Visitor (Name and Address): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom VISITOR’S REPORT  GUARDIANSHIP  CONSERVATORSHIP  COMBINED Instruction to court visitor: Please complete every applicable section of this form. If a section is not applicable, please enter N/A. I, (name), submit the following report concerning the investigation that I conducted as the court-appointed visitor in this  guardianship pursuant to §15-14-305, C.R.S.  conservatorship pursuant to §15-14-406, C.R.S. Summary: Yes No AA A lawyer should be appointed to represent the respondent.  Reason:  The respondent requested a lawyer.  Other: AA A guardian ad litem should be appointed to represent the respondent’s best interests.  Reason: AA A professional evaluator should be appointed to examine the respondent and  prepare an evaluation. Reason:  The respondent has demanded an evaluation.  Other: A A I believe the proposed guardianship, including the type of guardianship, is appropriate and that less restrictive means of intervention are unavailable.  Suggested limitations on guardian’s powers and duties: AA The nominated guardian should be appointed for the respondent.  A A I believe the proposed conservatorship, including the type of conservatorship, is appropriate and that less restrictive means of intervention are unavailable.  Suggested limitations on conservator’s powers and duties, and assets over which the conservator should be granted authority: ______________________________________________________________ A A The nominated conservator should be appointed for the respondent.  Yes No AA The respondent needs an interpreter.  If yes, for what language? _________________________ JDF 810 R8/17 VISITOR’S REPORT Page 1 of 8 ©2017 Colorado Judicial Department for use in the Courts of Colorado List any other persons involved who may need an interpreter, and for what language: ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ AA Significant concern(s): I. Observations: A. The activities of daily living (daily functions) that the respondent can manage without assistance; could manage with the assistance of supportive services or benefits, including the use of appropriate technological assistance; and cannot manage are as follows: B. The financial functions that the respondent can or cannot effectively manage: II. Interview of Respondent: I interviewed the respondent, in person, on (date) at (location). I provided the Notice of Rights to Respondent (JDF 797) and, to the extent the respondent was able to understand, explained the rights contained therein. A. Other persons present at the interview: B. Respondent’s physical appearance: C. Respondent was oriented to time and place  Yes  No D. After I explained the substance of the petition, the nature, purpose, and effect of the proceeding, and the general powers and duties of a guardian, conservator, or both, as appropriate to this case, I asked the following questions and the respondent answered as follows: JDF 810 R8/17 VISITOR’S REPORT Page 2 of 8 ©2017 Colorado Judicial Department for use in the Courts of Colorado 1. Do you understand what I’ve explained to you?  Yes  No  Did not respond If No, please explain or comment. 2. Do you understand the statement of rights (JDF 797)?  Yes  No  Did not respond 3. Do you have a lawyer?  Yes  No  Did not respond If Yes , please provide name: 4. Do you want a lawyer to be appointed for you?  Yes  No  Did not respond If Yes , please explain: 5. Do you have a doctor?  Yes  No  Did not respond If Yes , please provide name: 6. Is your doctor the same doctor who provided the letter attached to the petition filed in these proceedings?  Yes  No  Did not respond 7. Who are the family members or other people who are the most helpful to you? Guardianship Only 1. Do you need any help with your daily living activities or daily functions?  Yes  No  Did not respond If Yes , in what areas? 2. Do you know the proposed guardian?  Yes  No  Did not respond Proposed guardian is . 3. Do you think that he or she should be appointed as your guardian?  Yes  No  Did not respond 4. How do you feel about the proposed guardianship? (Scope, powers, duties and duration.)  Did not respond  Responded as follows: Conservatorship Only 1. Do you need any help with your finances?  Yes  No  Did not respond JDF 810 R8/17 VISITOR’S REPORT Page 3 of 8 ©2017 Colorado Judicial Department for use in the Courts of Colorado Identify specific areas (check writing, bill paying, etc.) 2. Do you know the proposed conservator?  Yes  No  Did not respond Proposed conservator is . 3. Do you think that he or she should be appointed as your conservator?  Yes  No  Did not respond 4. How do you feel about the proposed conservatorship? (Scope, powers, duties and duration.)  Did not respond  Responded as follows: III. Interview of Person Nominated as Guardian: A. Date and place of interview: B. Person seeking appointment was asked and responded as follows: 1. Name and address: 2. Relationship (including non-family) to respondent: 3. Occupation: 4. Why was this petition initiated? 5. Where has the respondent resided during the last three months? a. Who, if anyone, has been caring for the respondent during this period? JDF 810 R8/17 VISITOR’S REPORT Page 4 of 8 ©2017 Colorado Judicial Department for use in the Courts of Colorado b. What type of care has been provided?  None  In-home care  Assisted living  Hospital or nursing home c. What type of care will be provided if you are appointed as guardian?  None  In-home care  Assisted living  Hospital or nursing home 6. What changes in residence are contemplated?  None  Private home  Other facility. Please provide name and address: 7. What are your qualifications to be guardian for respondent? IV. Interview of Person Nominated as Conservator: A. Date and place of interview: B. Person seeking appointment was asked and responded as follows: 1. Name and address: 2. Relationship (including non-family) to respondent: 3. Occupation: 4. Why was this petition initiated? JDF 810 R8/17 VISITOR’S REPORT Page 5 of 8 ©2017 Colorado Judicial Department for use in the Courts of Colorado 5. Where has the respondent resided during the last three months? 6. Who, if anyone, has been handling the respondent’s financial affairs during this period? 7. Does the respondent owe you (conservator nominee) any money or property?  Yes  No If Yes, please explain. 8. Do you (conservator nominee) owe the respondent any money or property?  Yes  No If Yes, please explain. 9. What are your qualifications to be conservator for respondent? V. Interview of Petitioner, if Different than the Nominated Guardian or Conservator: A. Name of person: B. Date and place of interview: C. Petitioner was asked and responded as follows: 1. Occupation: 2. Have there been any significant changes since you filed the petition?  Yes  No Comments: VI. Interview of Other Interested Persons: A . Name of person: Relationship to respondent: B. Date and place of interview: C. Other person asked and responded as follows: 1. Address: JDF 810 R8/17 VISITOR’S REPORT Page 6 of 8 ©2017 Colorado Judicial Department for use in the Courts of Colorado 2. Occupation: 3. Should a guardian or conservator be appointed?  Yes  No Comments: Note: This section should be completed as many times as there are interested persons interviewed. Attach the additional interview notes to this report. VII. Report on Condition of Respondent’s Current Residence: A. Date visited: ____/____/____ B. Address: C. Type of dwelling: D. Condition: 1. Lawn and landscaping: 2. Exterior: 3. Interior: a. Utilities working  Yes  No Additional comments b. Clean  Yes  No Additional comments c. Fire hazards  Yes  No Additional comments d. Other (explain) E. I believe the respondent’s current dwelling meets his or her needs.  Yes  No VIII. Report on Condition of Respondent’s Proposed Residence, if a change is contemplated: A. Date visited: ____/____/____ B. Address: C. Type of dwelling: JDF 810 R8/17 VISITOR’S REPORT Page 7 of 8 ©2017 Colorado Judicial Department for use in the Courts of Colorado D. Condition: 1. Lawn an d landscaping : 2. Exterior: 3. Interior: a. Utilities working  Yes  No Additional comments b. Clean  Yes  No Additional comments c. Fire hazards  Yes  No Additional comments d. Other (explain) E. I believe the respondent’s proposed dwelling meets his or her needs.  Yes  No IX. Physicians or Other Persons Who Are Known to Have Treated, Advised, or Assessed the Respondent’s Relevant Physical or Mental Condition: Please identify the sources of the information: A. Physicians and psychiatrists: Comments: B. Psychologists and psychotherapists: Comments: C. Nurses and nurse aids: Comments: D. Other compensated health care providers: Comments: E. Family members, relatives, and friends: Comments: JDF 810 R8/17 VISITOR’S REPORT Page 8 of 8 ©2017 Colorado Judicial Department for use in the Courts of Colorado F. Others: Comments: I represent that there is no conflict of interest between any party and me.  By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form.  By checking this box, I am acknowledging that I have made a change to the original content of this form. (Checking this box requires you to remove JDF number and copyright at the bottom of the form.) Date: Signature of Court Visitor JDF 810 R8/17 VISITOR’S REPORT Page 9 of 8 ©2017 Colorado Judicial Department for use in the Courts of Colorado