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JDF 830 R6/13 LETTERS OF GUARDIANSHIP – MINOR © 2013 Colorado Judicial Department for use in the Courts of Colorado District Court Denver Probate Court ___________________ County, ColoradoCourt Address:In the Interest of:Minor COURT USE ONLY Case Number:Division Courtroom LETTERS OF GUARDIANSHIP - MINOR ( n am e o f g uard ia n) w as a ppoin te d o r c o nfir m ed b y th e C ourt o n ( d ate ) a s: g uard ia n p urs u ant to § 15 -1 4-2 04, C .R .S . T hese le tte rs s h all e xp ir e o n _ ______________, th e m in or’s 18th b ir th day, u nle ss o th erw is e o rd ere d b y t h e C ourt.e merg ency g uard ia n p urs u ant to § 15-1 4-2 04(5 ), C .R .S . T hese le tte rs s h all e xp ir e o n _ ______________ (a d ate n ot to e xce ed 6 0 d a ys fr o m th e d ate o f a ppoin tm ent) . T he g uard ia n’s p ow ers a re s p ecif ie d in th e Ord er. t em pora ry g uard ia n p urs u ant to § 15-1 4-2 04(4 ), C .R .S . T hese le tte rs s h all e xp ir e o n _ _______________ (a d ate n ot t o e xce ed s ix m onth s f r o m t h e d ate o f a ppoin tm ent) . 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). T hese L ette rs o f G uard ia nsh ip f o r t h e m in or w hose d ate o f b ir th is , a re p ro of o f th e g uard ia n’s fu ll a uth orit y t o a ct p urs u ant t o § 15-1 4-2 07, C .R .S ., e xce pt f o r t h e following restrictions: The m in or’s p la ce o f r e sid en ce s h all n ot b e c h anged fr o m th e S ta te o f C olo ra do w it h out a n o rd er o f th e C ourt p urs u ant t o § 15-1 4-2 08 (2 )(b ), C .R .S . O th er lim it a tio ns: _ ______ _________________________________________________________ _____ _______________ ________________________________________________________ _______ _______________ ________________________________________________________ D ate : _ ______ __________ ____________ _______________ ______ ______________ P ro bate R egis tr a r/( D eputy )C le rk o f C ourt C ER TIF IC A TIO N 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