Free Annual Report of the Guardianof the Person - Adult - New Hampshire

Instructions

Clear Form

THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us

Court Name: Case Name: Case Number:
(if known)

Guardianship of

ANNUAL REPORT OF THE GUARDIAN OF THE PERSON - ADULT
REPORTING PERIOD: 1. Guardian Name Mailing Address Guardian Name Mailing Address 2. Ward Name Date of Birth Mailing Address Residence address, if different from above 3. Name of facility where ward resides Type of facility: Private home Institution Contact Person 4. Describe the following: Supportive services being provided the ward: Group Home Other (specify) Telephone Nursing Home Telephone Telephone Telephone

Appropriateness of care and treatment:

5.

Describe physical health of ward Significant changes since last report Hospitalizations since last report Surgical procedures since last report Illnesses since last report

6.

Describe mental health of ward Psychiatric treatments since last report

NHJB-2166-P (10/01/2006) (formerly AOC-156A-003)

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Case Name: Guardianship of Case Number: ANNUAL REPORT OF THE GUARDIAN OF THE PERSON-ADULT

7.

Has there been any change of living conditions of the ward since the last report? Yes No If yes, please explain.

8.

Specify any proposed changes in the living situation of the ward.

9.

Specify guardian's plan for preserving and maintaining the well-being of the ward.

10.

Guardianship should be:

Continued

Terminated

Altered

Specify facts supporting your recommendation and provide any other information that may assist the court to better assess the general welfare of the ward.

I certify that I have sent a copy of this annual report to the ward.
Date Date Guardian Signature Guardian Signature

State of This instrument was acknowledged before me on My Commission Expires Affix Seal, if any

, County of by
Signature of Notarial Officer / Title

ORDER
Read and Noted. No further action is needed. Read and Noted. The following further action is needed:

Date
NHJB-2166-P (10/01/2006) (formerly AOC-156A-003)

Judge
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