Free Instructions - New Hampshire

Instructions for completing Annual Report of the Guardian of the PersonAdult
(NHJB-2166-P) Form use. RSA 464-A:35 requires that the guardian of an adult person (ward) file an annual report each year to report on the general status of the ward. A copy of this report must be sent to the ward.

Top section of form ·COURT NAME: Enter the name of the county probate court where the document will be filed. (example: Belknap County Probate Court; Rockingham County Probate Court). ·CASE NAME: Enter the name of the case (example: Guardianship of John Adams; Guardianship of Susan Jones). ·CASE NUMBER: Leave blank if not yet assigned by court OR fill in case number if it is known. ·REPORTING PERIOD: Enter the dates (FROM: month/day/year, TO: month/day/year) for this report. Numbered section of form 1. The Guardian Name is the name of the person filing this report. Enter that person's name, telephone number and complete mailing address with zip code. If there are co-guardians, enter the second person's name, telephone number and address information. The Ward Name is the name of the adult who is under guardianship. Enter the person's name, telephone number and complete mailing address with zip code. Enter the Residence Address, if the person's mailing address is different from his/her physical street address. The Name of Facility is the name of the facility in which the person is living, if applicable. Check off the Type of facility to indicate the kind of facility in which the person resides or check off `Other' and enter the specific type. Enter the name and telephone number of the Contact Person at this facility. Enter the Supportive services being provided the ward by describing the type of services this person receives such as mental health care, social services, rehab services etc. Enter your opinion of the Appropriateness of care and treatment received by the ward during this reporting period. Describe the Physical health of the ward by explaining the general overall health of the adult. List any Significant changes in the ward's health during this reporting period. Enter the dates and reasons for any Hospitalizations of the ward during this reporting period. Enter the dates and the Surgical procedure performed on the ward during this reporting period. List any Illnesses experienced by the ward during this reporting period. Describe the Mental health condition of the ward. List any Psychiatric treatments including therapy, medications or other treatments the person has received during this reporting period.
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NHJB-2166-P Instructions (06/26/2007)

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Check off either the `yes' or `no' box to indicate whether or not any Changes of living conditions may have occurred in the household or residence during this reporting period. If yes, explain the changes in detail. Explain any Proposed changes in the living arrangements of the person. Explain in detail your Plan for preserving and maintaining the well-being of the ward including continued care and support of the person.

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Check off the appropriate box that represents your recommendation to the court about this guardianship. There are three options: · Guardianship should be Continued would be used if the guardian maintains the current guardianship is in the best interest of the ward. · Guardianship should be Terminated if the guardian recommends that the current guardianship should end. · Guardianship should be Altered if the guardian recommends changes to the current guardianship arrangement to better provide for the care and welfare of the ward. Explain your reasons, specific facts and any other information you would like to give the court.

Signature section This form must be signed in the presence of a Notary Public or Justice of the Peace. They will complete the section immediately following your signature. You will sign the form on the Guardian Signature line, and date it in the appropriate space to the left. If there are two guardians, both guardians must sign and date the form. Order This section will be completed by the judge.

Review the completed form for accuracy prior to filing it with the court. If completing this form on-line, some fields may be filled in automatically based on entries in other fields. If more space is needed for any question, please attach additional sheets of paper.

NHJB-2166-P Instructions (06/26/2007)

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