Free Annual Report of Guardian on Condition of Ward, CC 16:10 - Nebraska

STATE OF NEBRASKA FORM NO. CC 16:10 9/88 New

ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD

CASE NUMBER

IN THE MATTER OF THE GUARDIANSHIP/CONSERVATORSHIP OF

ANNUAL REPORT OF GUARDIAN ON CONDITION OF WARD

(Ward) I, the undersigned, represent that I am the guardian/conservator of the above named ward, and that my annual report to the court is as follows: 1. 2. 3. Present age of ward: Current address of ward: Ward's residence is: own home nursing home foster or boarding home relative's home
(Relationship)

Date of birth:

guardian's home hospital or medical facility other:

4.

Ward has been in present residence since reasons for change:

. If moved within past year, state

5.

During the past year, how many times and on what dates did you see the ward?

6.

During the past year, the ward's mental health has: remained about the same. improved. Describe: deteriorated. Describe:

7.

During the past year, the ward's physical health has: remained about the same. improved. Describe: deteriorated. Describe:

Continued...

8.

During the past year, the ward has been treated or evaluated by the following: Physician. Name: Psychiatrist. Name: Social or other case worker. Name: Dentist. Name: Ward _____ is _____ is not under regular physician's care. Physician's Name:

9.

10.

Social conditions: During the past year, the ward has participated in the following activities: Describe. Recreational: Educational: Social: Occupational: None available. Refuses or unable to participate. As guardian, I rate my ward's living arrangements as: excellent. average. below average. If below average, explain:

11.

12.

As guardian, I believe my ward is: content with living situation. unhappy with living situation. As guardian, I believe my ward has the following needs that have not been met: The guardianship should be continued for the following reasons: Ward is still a minor. Ward's condition requires continuation of guardianship. I do is attached. do not have possession or control of the ward's estate. If yes, my accounting

13. 14.

15.

DATE:

GUARDIAN/CONSERVATOR:

(Telephone No.)