Fill and Sign the Wisconsin Guardianship Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE MATTER OF       Amended Letters of Guardianship of the Person (Due to Incompetency)       Date of Birth Case No.       To: Address:             You have been appointed: guardian co-guardian of the person. This is an appointment as a successor guardian. You have been appointed stand-by guardian and your authority to act commences on: (date)       and continues through (date)       . You are issued Letters of Guardianship of the Person with the following powers or limitations: Co-Guardians must concur with each other when making decisions on behalf of the ward unless otherwise ordered by the court as follows:       . The individual retains the right to exercise the following right(s) only with consent of the guardian of person : consent to marriage. apply for an operator’s license, a hunting, fishing or other license issued under ch. 29, or a credential as defined in §440.01(2), Wisconsin Statutes.       consent to sterilization. consent to organ, tissue, or bone marrow donation. The guardian of the person is authorized to exercise the following specific powers: See attached. consent to medical examination and treatment, and consent to voluntary medication, including psychotropic medication that is in the individual’s best interests, if the guardian has first made a good- faith attempt to discuss with the individual the individual’s voluntary receipt of the psychotropic medication and the individual does not protest. Guardian of person’s authority: full limited       authorize individual’s participation in an accredited or certified research project if the research project might help the individual, or others if minimal risk of harm. Guardian of person’s authority: full limited       authorize individual’s participation in research that might not help the individual but might help others if greater than minimal risk of harm to the individual but evidence indicates individual would have elected to participate. Guardian of person’s authority: full limited       consent to experimental treatment in the individual’s best interests. Guardian of person’s authority: full limited       consent to receipt by individual of social and supported living services Guardian of person’s authority: full limited       GN-3200, 10/06 Letters of Guardianship of the Person (Due to Incompetency) §§54.18, 54.25, 54.46(5), 54.52 and Chapter 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 GN-3200 Letters of Guardianship of the Person (Due to Incompetency) Page 2 of 2 Case No. consent to release of confidential records other than court, treatment, and patient health care records and redisclosure as appropriate. Guardian of person’s authority: full limited       power to make decisions related to mobility and travel . Guardian of person’s authority: full limited       power to choose providers of medical, social, and supported living services. Guardian of person’s authority: full limited       power to make decisions regarding educational and vocational placement and support services or employment. Guardian of person’s authority: full limited       power to make decisions regarding initiating a petition for termination of marriage. Guardian of person’s authority: full limited       power to receive all notices on behalf of individual. Guardian of person’s authority: full limited       power to act in all proceedings as an advocate of the individual, except the power to enter into a contract that binds the individual or the individual’s property or to represent the individual in any legal proceedings pertaining to the property, unless the guardian of the person is also the guardian of the estate. Guardian of person’s authority: full limited       power to apply for protective placement or for commitment. Guardian of person’s authority: full limited       power to have custody of the individual, if an adult, and the power to have care, custody, and control of the individual, if a minor. Guardian of person’s authority: full limited       other specific power(s):       The guardianship of the person terminates when the individual dies, when otherwise terminated by the court or when otherwise provided by law. These Letters of Guardianship of the Person supercede any previously issued Letters of Guardianship of the Person. Seal BY THE COURT: Circuit Court Judge/Court Commissioner       Name Printed or Typed       Date Name of Attorney       Address       Telephone Number       Bar Number       GN-3200, 10/06 Letters of Guardianship of the Person (Due to Incompetency) §§54.18, 54.25, 54.46(5), 54.52 and Chapter 54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2