Free Report to Accompany Petition to Appoint, Modify or Discharge Guardian of Individual with Developmental Disability - Michigan

Approved, SCAO

OSM CODE: RPD

STATE OF MICHIGAN PROBATE COURT COUNTY
CIRCUIT COURT - FAMILY DIVISION

REPORT TO ACCOMPANY PETITION TO APPOINT, MODIFY OR DISCHARGE GUARDIAN OF INDIVIDUAL WITH DEVELOPMENTAL DISABILITY

FILE NO.

In the matter of 1. I,
Name (type or print)

, an individual with an alleged developmental disability , report to the court that:

2. The individual's developmental disability may be described as follows: Nature:

Type:

3. The appended evaluations are current, take into account the individual's abilities, and were performed and signed by the following individuals: Evaluation Name Title Date Performed Mental Physical Social Educational Adaptive Behavior Social Skills 4. Appended to the report is a listing of all psychotropic medication, plus all other medication that the individual is receiving on a continuous basis, the dosage of the medication, and a description of the impact upon his or her mental, physical and educational condition, adaptive behavior, and social skills. should be modified is needed is not needed.

5. Guardianship

for the following reason(s):

PLEASE SEE OTHER SIDE
Do not write below this line - For court use only

PC 659 (3/00)

REPORT TO ACCOMPANY PETITION TO APPOINT, MODIFY OR DISCHARGE GUARDIAN OF INDIVIDUAL MCL 330.1612; MSA 14.800(612) WITH DEVELOPMENTAL DISABILITY

6. The type and scope of guardianship services needed are as follows:

7. The recommendations and reasons for the most appropriate rehabilitation plan are as follows:

8. The recommendations and reasons for the most appropriate living arrangements are as follows:

The guardian should be authorized to make application to place the individual in
Name or type of facility

.

Date

Signature of person preparing report Name of center or agency Address City, state, zip Telephone no.