Form Gc 333 PDF Details

In the intricate landscape of legal documentation pertaining to conservatorships, the GC-333 form emerges as a pivotal document. This form is an essential part of a conservatorship case in the Superior Court of California, facilitating a critical step in the appointment of a conservator for individuals who may not be in a position to manage their own health or financial affairs. The form encompasses an Ex Parte Application for Order Authorizing Completion of Capacity Declaration—HIPAA, a process integral to assessing the medical condition or mental capacity of the proposed conservatee. It intricately specifies the need for a Capacity Declaration and, if applicable, a Major Neurocognitive Disorder Attachment, shedding light on the proposed conservatee's health status without violating HIPAA's stringent privacy rules. The detailed sections of the form delineate various requests, such as excusing the proposed conservatee from attending the hearing, bestowing exclusive authority for medical decisions to the conservator, and making critical placement or medication decisions. The necessity for this form underscores the delicate balance between safeguarding an individual's rights and ensuring their well-being through a conservatorship, illustrating the procedural steps required for a prospective conservator to obtain lawful access to sensitive medical information crucial for the court's informed decision-making.

QuestionAnswer
Form NameForm Gc 333
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescalifornia application order authorizing, application completion hipaa online, order authorizing, california declaration form sample

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GC-333

ATTORNEY OR PARTY WITHOUT ATTORNEY

STATE BAR NUMBER:

FOR COURT USE ONLY

 

 

 

 

NAME:

 

 

 

FIRM NAME:

 

 

 

STREET ADDRESS:

 

 

 

CITY:

STATE:

ZIP CODE:

 

TELEPHONE NO.:

FAX NO.:

 

 

E-MAIL ADDRESS:

 

 

 

ATTORNEY FOR (name):

 

 

 

SUPERIOR COURT OF CALIFORNIA, COUNTY OF

 

 

 

STREET ADDRESS:

 

 

 

 

 

MAILING ADDRESS:

 

 

 

 

 

CITY AND ZIP CODE:

 

 

 

 

 

BRANCH NAME:

 

 

 

 

 

 

 

 

 

 

 

CONSERVATORSHIP OF THE

 

PERSON

 

ESTATE OF

CASE NUMBER:

 

 

 

 

 

(Name):

 

 

 

 

 

 

 

 

 

CONSERVATORSHIP PETITION HEARING DATE:

 

 

 

 

 

PROPOSED CONSERVATEE

EX PARTE APPLICATION FOR ORDER AUTHORIZING

DEPT.:

TIME:

COMPLETION OF CAPACITY DECLARATION—HIPAA*

1.Applicant (name):

has filed a petition for the appointment of a conservator for the above-named proposed conservatee. The petition is set for

hearing on (date):

at (time):

in

 

Dept.:

 

Rm.:

 

 

2.The petition requests (check all that apply):

a.

 

A finding that the proposed conservatee should be excused from attending the hearing on the petition.

b.

 

Exclusive authority to consent to medical treatment for the proposed conservatee.

 

c.

 

Authority to make placement or medication decisions related to a major neurocognitive disorder (such as dementia).

 

d.

 

Appointment of a conservator of the estate.

 

e.

 

Other (specify):

 

3. Applicant has requested (name each declarant):

to complete, sign, and deliver to applicant, for use to support the petition, a Capacity Declaration—Conservatorship (form GC-335)

and a Major Neurocognitive Disorder Attachment to Capacity Declaration—Conservatorship (form GC-335A) (the Declaration), concerning the medical condition or mental capacity of (name of proposed conservatee):

4.The proposed conservatee has not consented to the disclosure of any private medical information that would be disclosed by the completed Declaration.

5.Applicant requests this court to authorize each declarant named in item 3 to complete, sign, and deliver the Declaration to applicant within 15 days of the declarant's receipt of the court's order.

6.Applicant requests this court to dispense with notice of hearing on this application.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

(TYPE OR PRINT APPLICANT'S NAME)

(APPLICANT'S SIGNATURE )

*The federal Health Insurance Portability and Accountability Act of 1996. Use this form with Ex Parte Order Re Completion of Capacity Declaration—HIPAA (form GC-334).

 

 

Page 1 of 1

 

 

 

Form Adopted for Mandatory Use

EX PARTE APPLICATION FOR ORDER AUTHORIZING

Probate Code, §§ 1220, 1825, 1890,

Judicial Council of California

1893, 2356.5;

 

GC-333 [Rev. January 1, 2019]

COMPLETION OF CAPACITY DECLARATION—HIPAA

42 U.S.C. §§ 1177, 1178;

 

(Probate—Guardianships and Conservatorships)

45 C.F.R. §§ 160, 164

 

www.courts.ca.gov

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