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IN THE DISTRICT COURT OF STATE OF OKLAHOMA

COUNTY

In the Matter of the Guardianship of

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P­ ___________________

Report on the Guardianship of the Person
I, _____________________________________, the _____ guardian, or, _____ limited guardian of the person, for _________________________________ (name), _____ an incapacitated, or, _____ a partially incapacitated person, hereby submit this _____ annual, or, _____ court-ordered Guardianship Report.

1.

The current place of abode of the ward is: ______________________________________________________________________ ______________________________________________________________________

2.

The type of home or facility in which the ward lives is _________________________________, and the name of the person in charge of the home or facility is ______________________________.

3.

My present street address and telephone number is: ______________________________________________________________________ ______________________________________________________________________

4.

During the last year, I have seen the ward ________ times. I otherwise or also have become or remained familiar with the needs and care of the ward as follows: ______________________________________________________________________ ______________________________________________________________________

The nature of my visits to the ward has been: ______________________________________________________________________ ______________________________________________________________________

5.

The following services are currently being provided to the ward: ______________________________________________________________________ ______________________________________________________________________

6.

These services _____ are, or, _____ are not provided for in the current Guardian Plan. The reason they are not shown in the current Guardian Plan is: ______________________________________________________________________ ______________________________________________________________________

7.

The ward was last seen by a physician on: The purpose of the visit was:

__________________________________________

______________________________________________________

8.

I _____ have, or, _____ have not observed any major change in the ward's physical or mental condition during the last year. If so, these are my observations: ______________________________________________________________________ ______________________________________________________________________

9.

I _____ have, or, _____ have not taken any significant action for or on behalf of the ward since the last time I submitted a Guardianship Report. If so, I took the following actions: ______________________________________________________________________ ______________________________________________________________________

10. There _____ have, or, _____ have not been any significant problems relating to the ward or to my guardianship of the ward since the last time I submitted a Guardianship Report, or, if this is an initial report, since the issuance of my letters. If so, I have observed these problems: ______________________________________________________________________ ______________________________________________________________________

11. It is my opinion that the guardianship _____ should, or, _____ should not be continued. If so, the basis for my belief is as follows: ______________________________________________________________________ ______________________________________________________________________

12. I believe the ward _____ would, or, _____ would not be able to manage essential requirements for physical health and safety with fewer restrictions on the ward's ability to act for himself or herself. If so, the basis for my belief is as follows: ______________________________________________________________________ ______________________________________________________________________

13. My opinion of the present care being provided to the ward is as follows:

______________________________________________________________________ ______________________________________________________________________

14. The place of abode of the ward _____ has, or, _____ has not changed since the last guardianship report. If so, the place of abode of the ward was changed for the following reasons: ______________________________________________________________________ ______________________________________________________________________

I hereby swear that the answers set forth above are true and correct to the best knowledge and belief of the undersigned, subject to the penalties of making a false affidavit or declaration.

_____________________________________________________
Signature of Guardian or Limited Guardian

________________________
Date

_____________________________________________________
Telephone

AOC Form 34
Revised 8/05