IN THE CIRCUIT COURT OF THE ELEVENTH JUDICIAL CIRCUIT, IN AND FOR MIAMI-DADE COUNTY, FLORIDA, PROBATE DIVISION
Initial Guardianship Plan
1. The Ward's present location is:
2. The Guardian for the plan period proposes the following as to the provision of medical and rehabilitative services for the Ward:
3. The Guardian for the plan period proposes the following as to the provision of mental health services for the Ward:
4. The Ward presently is prescribed or takes the following types of medications:
5. The guardian for the plan period proposes the following as to the provision of personal care services for the Ward:
6. The guardian for the plan period proposes the following as to the provision of social/recreational services for the Ward:
7. The Guardian for the plan period proposes the following as to the provision of social services for the Ward:
8. The Guardian states the place and kind of residential setting best suited for the needs of the Ward is:
9. The Ward has the following health insurance, accident insurance, private benefits, or governmental benefits available to meet the costs of medical, mental health, or related services:
10. The Guardian will secure the following physical/mental examinations to determine the Ward's medical and mental health treatment needs:
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Physical/Mental Examinations
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Provider's Name, Address, and Phone Number
Type of Provider
Approximate Date of Exam
11. To assist the Court with review of the initial plan to determine if it is in the best interest of the Ward, please provide the following information:
A. Please rate the ability of the Ward to engage in activities of daily living or instrumental activities of daily living:
B. The diagnosed mental disabilities of the Ward are:
C. The diagnosed physical disabilities of the ward are:
D. The assistive devices used by the Ward are:
E. The plan for the next twelve (12) months for disaster preparedness for the Ward is:
12. Please list, for adult wards only, any preexisting orders not to resuscitate executed under §401.45(3), Fla. Stat. or preexisting advance directives as defined in §765.101, Fla. Stat., including the date an order or directive was signed, whether such order or directive has been suspended by the court, and a description of the steps taken to identify and locate the preexisting “order not to resuscitate” or “advance directives”.
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#
Title of Order/Directive
Date of Order/Directive
Suspended by Court (Yes/No)
Steps Taken to Identify and Locate Order/Directive
13.To assist the court in providing demographic information to private and public entities, please provide the following information:
CERTIFICATION AND SIGNATURE OF GUARDIAN(S)
CERTIFICATION AND SIGNATURE OF PREPARER
The preparation of this form is based upon the information provided by the guardian(s) and/or attorney with no independent verification of the information contained herein. I have not audited or reviewed the guardianship plan or documents supporting the preparation of the guardianship plan and, accordingly, do not express an opinion or any other form of assurance as to the accuracy of the information contained in the plan.
CERTIFICATION AND SIGNATURE OF GUARDIAN'S ATTORNEY
The undersigned hereby notifies the Court of the filing of the initial guardianship plan of the guardian of the person. This initial plan is the representation of the guardian. I have not audited the accompanying initial guardianship plan. The undersigned attorney represents that he/she has examined the contents of this plan and that it conforms to the requirements of the Florida Guardianship Law.