Fill and Sign the Visitors Report Colorado Form

 District Court  Denver Probate 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 I, ______________________________________ (name), submit the following report concerning the investigation which I have 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. Recommendations: The Court Visitor interviewed the Respondent in person on ____________________ (date). Yes No AA A Guardian should be appointed for the Respondent.   AA A Conservator should be appointed for the Respondent.   AA Respondent is objecting to the Guardianship and/or Conservatorship proceeding.   A A Respondent is objecting to the nominated Guardian and/or Conservator.   AA Respondent has requested an attorney.   Pursuant to §15-14-305(3)(c), C.R.S and/or §15-14-406(3)(c), C.R.S A A Respondent has been advised of payment of fees in this proceeding.   Pursuant to § 15-14-305(3)(c)& (d), C.R.S and/or §15-14-406 (3)(c) & (d), C.R.S Explain: _________________________________________________________ A A An Attorney should be appointed to represent the Respondent.   Explain: _________________________________________________________ AA A Guardian ad Litem should be appointed for the Respondent.   Explain: _________________________________________________________ AA A professional evaluation or further evaluation should occur.   Pursuant to §15-14-305(5)(f) and/or § 15-14-406(6), C.R.S. Explain: _________________________________________________________ JA The Respondent has been advised of their rights.   Pursuant to §15-14-305, C.R.S. and/or §15-14-406, C.R.S. KA Significant concern(s) of the Court Visitor.   Explain: I. Summary of Observations: A. Describe 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: JDF 810 R4/09 VISITOR’S REPORT Page 1 of 7 B. Describe the financial functions that the Respondent can or cannot effectively manage: Appendix 1. I have provided the  Notice of Rights to Respondent (JDF 797) and have explained the following rights:  to employ and consult with a lawyer at the Respondent’s own expense and the right to request a Court- appointed lawyer.  to be present in person at any Court proceeding and to see or hear all evidence bearing on Respondent’s condition;  to present evidence;  to cross-examine witnesses, including any Court-appointed visitor or physician;  to have a closed hearing on any issue;  to contest the Petition;  to object to the appointment of the proposed Guardian/Conservator or his/her powers or duties;  to object to the creation of the proposed Guardianship/Conservatorship or the scope or duration thereof; and  to have a Guardian ad Litem appointed to represent his/her interests if the Court determines that a need for such representation exists. II. Interview of Respondent: A. Date and place of interview: B. Other persons present: C. Respondent’s physical appearance: D. Was Respondent oriented as to time and place?  Yes  No JDF 810 R4/09 VISITOR’S REPORT Page 2 of 7 E. After my explanation of 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, the Respondent was asked and responded as follows: 1. Do you understand that explanation?  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 an attorney?  Yes  No  Did Not Respond If Yes , please provide name: 4. Do you want an attorney 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 provide 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 Identify what specific areas (check writing, bill paying, etc.)? JDF 810 R4/09 VISITOR’S REPORT Page 3 of 7 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 Seeking Appointment 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. Why was this Petition initiated? 4. Where has the Respondent resided during the last three months? a. Who, if anyone, has been caring for the Respondent during this period? b. What type of care has been provided?  None.  In-Home Care. JDF 810 R4/09 VISITOR’S REPORT Page 4 of 7  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 5. What changes in residence are contemplated?  None.  Private Home. Please provide name and address.  Other Facility. Please provide name and address. IV. Interview of Person Seeking Appointment 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. Why was this Petition initiated? 4. Where has the Respondent resided during the last three months? 5. Who, if anyone, has been handling the Respondent’s financial affairs during this period? JDF 810 R4/09 VISITOR’S REPORT Page 5 of 7 6. Does the Respondent owe you (Conservator nominee) any money or property?  Yes  No If Yes, please explain. 7. Do you (Conservator nominee) owe the Respondent any money or property?  Yes  No If Yes, please explain. V. Interview of Other Interested Person: A. Name of Person: ______________________________ Relationship to Respondent: _________ B. Date and place of interview: C. Other person asked and responded as follows: 1. Address: _______________________________________________________________ 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. Attach the additional interview notes to this report. VI. Report on Condition of Respondent’s Present Residence: A. Date ____/____/____  Visited  Information otherwise obtained: B. Address: C. Type of Abode: D. Condition (if at home): 1. Lawn and Landscaping: 2. Exterior: 3. Interior: JDF 810 R4/09 VISITOR’S REPORT Page 6 of 7 a. Utilities working  Yes  No Additional comments b. Clean  Yes  No Additional comments c. Fire Hazards  Yes  No Additional comments d. Other (explain) VII. Report on Condition of Respondent’s Proposed Residence, if applicable: A. Date ____/____/____  Visited  Information otherwise obtained: B. Location and type of place: C. 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) VIII. 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: B. Psychologists and Psychotherapists: C. Nurses and Nurse Aids: JDF 810 R4/09 VISITOR’S REPORT Page 7 of 7 D. Other Compensated Health Care Providers: E. Family Members, Relatives, and Friends: F. Others: The Court Visitor represents that there is no conflict of interest between the Court Visitor and any party. Date: ______________________ ___________________________________________ Signature of Court Visitor JDF 810 R4/09 VISITOR’S REPORT Page 8 of 7