Free GC-385 ORDER AUTHORIZING CONSERVATOR TO GIVE CONSENT FOR MEDICAL TREATMENT - California

COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address):

Index No.
FOR COURT USE ONLY

GC-385

TELEPHONE AND FAX NOS.:

: Plaintiff(s)
ATTORNEY FOR (Name):

Calendar No.

: : : :

JUDICIAL SUBPOENA

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

-against-

CONSERVATORSHIP OF THE

Defendant(s) : ......................................................
CONSERVATEE

PERSON

ESTATE

OF (Name):

ORDER AUTHORIZING CONSERVATOR TO GIVE CONSENT FOR MEDICAL TREATMENT

CASE NUMBER:

THE PEOPLE OF THE STATE OF NEW YORK
1. The petition for authority to give consent for medical treatment came on for hearing as follows (check items c, d, e, and f to indicate personal presence): a. Judge (name): Time: b. Hearing date: c. Petitioner (name): d. Attorney for petitioner (name): e. GREETINGS: conservatee (name, address, and telephone): Attorney for f.

TO

Dept.:

Div.:

Room:

WE COMMAND YOU, thatunable to attend excuses being laid aside, you and each of you attend before all business and Conservatee was present able but unwilling to attend and does not wish to contest the , the Honorable out of state. at the Court petition THE COURT FINDS located at County of 2. a. in room required byon the All notices , law have been given. day of , 20 , at o'clock in the noon, and at any recessed b. or adjourned no form of medical treatment for which the witness in this action on the part of the There is date, to testify and give evidence as a conservatee has the capacity to give informed consent.
Conservatee is an adherent of a religion that relies on prayer alone for healing as defined in Probate Code section 2355(b). Attorney (name): has been appointed by the court as legal counsel to represent the conservatee in this proceeding. The cost for representation is: $ e. Conservatee has dementia as defined in Probate Code punishable as aand the court finds alland will make you to make Your failure to comply with this subpoena is section 2356.5, contempt of court other facts required liable to the orders specified in item 4. the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a THE COURT ORDERS result of your failure to comply. Conservatee lacks the capacity to give informed consent for medical treatment and the conservator of the person is 3. a. granted the powers specified in Probate Code section 2355. c. d. b. c. d.

Witness, Honorable , one of the Justices section The treatment shall be performed by an accredited practitioner of the religion defined in Probate Code of the 2355(b). Court in order dated: County, day of , made under Probate Code section 1880 is 20 revoked The
modified as stated below For legal services rendered, conservatee (name): as follows (specify terms): Other (specify): as stated in Attachment 3c. conservatee's estate shall pay to the sum of: $ forthwith (Attorney must sign above and type name below)

e.

Attorney(s) for
f. Letters of Conservatorship shall reissue and include a statement that conservator has the powers ordered. g. This order shall terminate on (date): 4. a. The conservator of the person is granted authority to place conservatee in a care or nursing facility described in Probate Code section 2356.5(b). b. Office and P.O. medications appropriate for the care The conservator of the person is granted authority to authorize the administration ofAddress and treatment of dementia described in Probate Code section 2356.5(c). 5. Total boxes checked in items 2-4: _____ 6. Number of pages attached: _____ Date:

Form Approved by the Judicial Council of California GC-385 [Rev. January 1, 1998] Mandatory Form [1/1/2000]

ORDER AUTHORIZING CONSERVATOR TO GIVE CONSENT FOR MEDICAL TREATMENT

Telephone No.: Facsimile No.: OF THE SUPERIOR COURT JUDGE E-Mail Address: ATTACHMENT SIGNATURE FOLLOWS LAST Mobile Tel. No.: Probate Code, § 1880 et seq.
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