Guardians Report {17.7}

PROBATE COURT OF HAMILTON COUNTY, OHIO RALPH WINKLER, JUDGE GUARDIANSHIP OF___________________________________________________________ CASE NO.__________________ GUARDIAN'S REPORT [R.C. 2111.49 and Sup.R. 66.05(B)(2)] NOTE: If allotted space is inadequate to respond, write "See Exhibit" in the space and add appropriate exhibit letter sequence, then attach exhibit containing information requested for that space. 1. 2. This is the (circle one): 1st, 2nd, 3rd, 4th, 5th, 6th, or_____________, Guardian's Report. Ward's present address: _________________________________________________________ City __________________________________ State _______________ Zip __________ Telephone (______) ___________________________ Ward's living arrangements at the above address are best described as: a. His or her own apartment or home (includes assisted living facilities). b. Private home or apartment of: (1) the ward's guardian (2) a relative of the ward, whose name is ________________________________ and relationship is __________________________________________________ (3) a non-relative whose name is_______________________________________ c. d. e. f. A foster, group or boarding home. A nursing home. A medical facility or state institution. Other (describe)__________________________________________________________ _______________________________________________________________________ g. If c, d, e or f is checked, complete the following: (1) The name of the home, facility or institution_______________________________ _______________________________________________________________________ (2) The name of an individual at the home, facility or institution who has knowledge and is authorized to give information to the Court about the ward. Name ____________________________________________________________ Telephone Number ( _________ ) ______________________________________ The ward will be at the address given in Item 2: a. Indefinitely. b. Temporarily. The new address and telephone number is: (1) Unknown. I will provide this information when known. (2) _____________________________________________________________________ City_________________________________________ State ______________________ Zip_______________________Telephone (_______)_______________________ 3. 4. American LegalNet, Inc. www.FormsWorkFlow.com PAGE 1 of 2 FORM 17.7 ­ GUARDIAN'S REPORT 3/01/17 CASE NO. ________________ 5. Guardian's contact with the ward: a. Approximate number of times the guardian had contact with the ward during the period covered by this report: _______________________________________________________. b. The nature of those contacts (phone, personal, or other): ___________________________________ _________________________________________________________________________________ c. Date the ward was last seen by the guardian: _____________________________________ Have you observed any major change in the ward's physical or mental condition during the period covered by this report? Yes No If "yes" is checked, briefly describe the changes. ______________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ The care given to the ward is Adequate Not Adequate If "Not Adequate" is checked, explain. _______________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ The guardianship should be Continued Not Continued If "Not Continued" is checked, explain. ______________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ During the period covered by this report, the ward has has not been seen by a physician. If the ward has been seen, the last date was_________________________________________ and for the purpose of________________________________________________________________ I currently serve as the Guardian to ten or more wards and certify to the court that I am unaware of any circumstances that may disqualify me from serving as Guardian of this Ward. With regard to the continuing education requirement pursuant to Sup. R. 66.07: I have completed the continuing education requirement. (Attach Certificate of Completion if applicable) The continuing education requirement was waived. 6. 7. 8. 9. 10. 11. Attached is a statement by a licensed physician, a licensed clinical psychologist, a licensed social worker, or a mental retardation team, that has evaluated or examined the ward within three months prior to the date of this report regarding the need for continuing the guardianship. [R.C.2111.49(A)(1)(i)](Form 17.1) If an attorney has been consulted on this report: ______________________________________ Attorney for Guardian ______________________________________ Street ______________________________________ City, State, Zip Code ______________________________________ Telephone Number (include area code) ______________________________________ Attorney Registration No. Date__________________________________________ ______________________________________________ Guardian's Printed Name ______________________________________________ Guardian's Signature ______________________________________________ Street ______________________________________________ City, State, Zip Code ______________________________________________ Telephone Number (include area code) ______________________________________________ E-mail Address (Knowingly giving false information on a Probate document is a criminal offense.) [R.C. 2921.13(A)(11)] American LegalNet, Inc. www.FormsWorkFlow.com PAGE 2 of 2 FORM 17.7 ­ GUARDIAN'S REPORT 3/01/17