Guardian Report Annual Form PDF Details

The Guardian Report Annual form is an essential tool in the State of Michigan for overseeing the welfare of legally incapacitated individuals. It requires guardians to provide a comprehensive yearly update on several aspects of the ward's life, ensuring their well-being is continuously monitored and adequately addressed. This update encompasses the living arrangements, physical and mental health conditions, social activities, and the financial situation of the individuals under guardianship. The report mandates a detailed account of the ward's current residence, health status—including any medical treatments received within the year—and their involvement in social or recreational activities. Additionally, it enquires about do-not-resuscitate orders, the guardian's visits, activities performed on behalf of the ward, consultations with the ward, and any unmet needs. Importantly, the form also addresses whether the guardianship should continue and if there have been any changes in the ward's financial situation. Fulfilling this report involves serving the completed document to the ward and all interested parties, followed by filing it along with a proof of service to the probate court, underscoring the legal accountability and transparency required from guardians in safeguarding the interests of their wards.

QuestionAnswer
Form NameGuardian Report Annual Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesguardianship yearly michigan, michigan report guardianship, during guardian report, pc634

Form Preview Example

 

 

PCS CODE: AGW

Approved, SCAO

 

TCS CODE: AGW

 

 

 

STATE OF MICHIGAN

ANNUAL REPORT OF GUARDIAN ON

FILE NO.

PROBATE COURT

CONDITION OF

 

COUNTY OF

LEGALLY INCAPACITATED INDIVIDUAL

 

 

FINAL REPORT

 

 

 

 

NOTE: This report must be completed yearly by the guardian, or more often if directed by the court. The guardian must serve the completed report on the ward and all interested persons as required by Michigan Court Rules 5.105 and 5.125.

Then the guardian must complete a proof of service (form PC 564) and ile it and this report with the court.

In the matter of

 

 

 

 

 

 

 

, a legally incapacitated indidvidual

 

 

 

First, middle, and last name

 

 

 

 

 

 

 

 

1.

I,

 

 

 

 

, am the guardian of the adult named above and my annual

 

 

Name (type or print)

 

 

 

 

 

 

 

 

 

report for the period of

 

 

to

 

 

 

 

 

is as follows.

 

 

 

Date

 

 

Date

 

 

 

 

 

2.

Present age of the adult:

 

Date of birth:

 

3.

Living Arrangement

 

 

 

 

 

 

 

 

 

a. The current address and telephone number of the adult are:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check here if this is a new address

b.The name of the facility where the adult resides, if any:

c.The adult's residence is:

own home/apartment

guardian's home/apartment

other:

nursing home

hospital or medical facility

 

 

(boarding home, assisted living, etc.)

 

 

 

 

foster home

relative's home:

 

 

 

 

 

 

 

Relationship

 

 

 

 

d. The adult has been in the present residence since

 

 

 

. If moved within the past year, state

the changes and the reasons for change.

Date

 

 

 

 

 

 

 

 

 

 

e. I rate the adult's living arrangement as

excellent.

average.

below average.

Explain

f. I believe the adult is

content with the living situation.

unhappy with the living situation.

g. I recommend a more suitable living arrangement for the adult as follows:

(SEE SECOND PAGE)

USE NOTE: If this form is being iled in the circuit court family division, please enter the court name and county in the upper left-hand corner of the form.

Do not write below this line - For court use only

MCL 700.5314(e), (g), MCL 700.5317, MCR 5.409(A)

PC 634 (9/16) ANNUAL REPORT OF GUARDIAN ON CONDITION OF LEGALLY INCAPACITATED INDIVIDUAL

4. Physical Health

 

 

 

 

a. The adult's current physical condition is

excellent.

good.

fair.

poor.

b.During the past year the adult's physical condition has remained about the same.

improved. Explain

worsened. Explain

c.During the past year the adult received the following medical treatment (include check-ups and dental work):

Date

Ailment

Type of Treatment

Doctor’s Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.Do-Not-Resuscitate Order

a. I did not execute, reafirm, or revoke a do-not-resuscitate order.

b. I

executed

 

reafirmed

revoked

a do-not-resuscitate order for the adult under MCL700.5314(d).

In doing so, I

did

did not

consult with the adult and his/her attending physician.

6. Mental Health

 

 

 

 

a. The adult's current mental condition is

excellent.

good.

fair.

poor.

b.During the past year, the adult's mental condition has remained about the same.

improved.

Explain

 

 

 

worsened.

Explain

 

 

 

c. During the past year, treatment or evaluation by a psychiatrist, psychologist, or social worker

was

was not

provided.

 

 

 

 

7. Social Activities/Services

 

 

 

 

a. The adult's current social condition is

excellent.

good.

fair.

poor.

b.During the past year, the adult's social condition has remained about the same.

improved. Explain

worsened. Explain

c.During the past year, the adult has participated in the following activities: recreational

educational

social

occupational

No activities were available.

The adult refused to participate in any activities.

The adult was unable to participate in any activities.

(SEE THIRD PAGE)

8.List of Visits

a. During the past year, I visited the adult as follows:

List dates

b. The average amount of time I spent on each visit was

 

.

c. The last time I visited with the adult was on

.

 

Date

 

 

 

9.Activities

During the past year, I performed the following activities on behalf of the adult:

10.Consultation

During the past year, I consulted with the adult before making the following decisions:

11.I believe the adult has the following unmet needs:

12. The guardianship

should

should not

be continued because:

Note: If you no longer wish to serve as guardian, you must ile a petition to remove yourself.

13. There

is

is not

more cash or property than what was previously reported to the court.

If there is, specify the additional amount: $

 

.

14. As guardian, I have been ordered by the court to ile an annual account, which is attached.

Date

 

Signature

 

 

 

 

 

Address

 

City, state, zip

Telephone no.

Check here if this is a new address

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annual guardianship report form michigan writing process described (portion 1)

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