Florida Probate Rule 5.904
RULE 5.904. FORMS FOR INITIAL AND ANNUAL GUARDIANSHIP
PLANS
(a) Initial Guardianship Plan for Minor.
In the Circuit Court of the
Judicial
Circuit,
in and for
County, Florida
Probate Division
Case No.
In Re: Guardianship of
Minor Ward
INITIAL GUARDIANSHIP PLAN FOR MINOR
.....(Guardian’s name)....., the guardian of the person of .....(ward’s
name)....., submits the following annual plan for the period beginning on
.....(beginning date)..... and ending on .....(ending date)....., for the benefit of the
ward.
1. The ward’s address at the time of filing this plan is:
2. The medical, dental, mental, or personal care services for the
welfare of the ward that will be provided during the upcoming year are:
Provider Type of Service to be Provided
3. The social and personal services to be provided for the welfare of
the ward during the upcoming year are:
4. The place and kind of residential setting best suited for the needs
of the ward is:
5. The physical and/or mental examinations necessary to determine
the ward’s medical, dental, and mental health treatment needs are:
6. Education of the ward:
Name and address of the school the ward will attend:
Grade level of ward:
Description of classes the ward will attend:
7. Consulting with ward (Check 1):
( ) a. The ward is under age 14;
OR
( ) b. The guardian attests that the guardian has consulted
with the ward (if ward is 14 years of age or older) and, to the extent reasonable,
honored the ward’s wishes consistent with the rights retained by the ward
under the plan, and to the maximum extent reasonable, the plan is in
accordance with the wishes of the ward.
8. This initial plan does not restrict the physical liberty of the ward
more than is reasonably necessary to protect the ward from serious physical
injury, illness, or disease and provides the ward with medical care and mental
health treatment for the ward’s physical and mental health.
(Please use additional sheets if necessary.)
Under penalties of perjury, I declare that I have completed and read
the foregoing, and the facts set forth are true, to the best of my
knowledge and belief.
Signed on .....(date)......
[A certificate of service is required if ward is 14 years of age or older.]
[I certify that the foregoing document has been furnished to .....(name,
address used for service, mailing address, and e-mail address)..... by (e-mail)
(delivery) (mail) (fax) on .....(date)…...]
Guardian’s Signature
Guardian’s Printed Name:
Guardian’s Address:
Guardian’s Phone Number:
Guardian’s E-mail Address:
If the guardian is represented by counsel, the attorney must comply with
Florida Rule of General Practice and Judicial Administration 2.515.
(b) Annual Guardianship Plan for Minor.
In the Circuit Court of the
Judicial
Circuit,
in and for
County, Florida
Probate Division
Case No.
In Re: Guardianship of
Minor Ward
ANNUAL GUARDIANSHIP PLAN FOR MINOR
.....(Guardian’s name)....., the guardian of the person of .....(ward’s
name)....., submits the following annual plan for the period beginning on
.....(beginning date)..... and ending on .....(ending date)......
1. The ward’s address at the time of filing this plan is:
. During the prior 12 months, the ward resided at (include dates, names,
addresses, and length of stay at each location):
Date Name Address Length of stay
2. List any professional treatment (medical or dental) given to the
ward during the prior 12 months:
Date Provider Treatment provided
Date Provider Treatment provided
3. A report from the physician who examined the ward no more than
180 days before the beginning of the applicable reporting period that contains
an evaluation of the ward’s physical and mental conditions has been filed with
this plan. [See subdivision (e) of this rule for a format for a physician’s report.]
4. The plan for providing medical or dental services in the coming
year:
5. A summary of the ward’s school progress report:
6. A description of the ward’s social development, including how well
the ward communicates and maintains interpersonal relationships:
7. The social needs of the ward are:
8. Consulting with ward (Check 1):
( ) a. The ward is under age 14;
OR
( ) b. The guardian attests that the guardian has consulted
with the ward (if ward is 14 years of age or older) and, to the extent reasonable,
honored the ward’s wishes consistent with the rights retained by the ward
under the plan, and to the maximum extent reasonable, the plan is in
accordance with the wishes of the ward.
(Please use additional sheets if necessary.)
Under penalties of perjury, I declare that I have completed and read
the foregoing, and the facts set forth are true, to the best of my
knowledge and belief.
Signed on .....(date)......
[A certificate of service is required if ward is 14 years of age or older.]
[I certify that the foregoing document has been furnished to .....(name,
address used for service, mailing address, and e-mail address)..... by .....(e-
mail) (delivery) (mail) (fax)..... on .....(date)…...]
Guardian’s Signature
Guardian’s Printed Name:
Guardian’s Address:
Guardian’s Phone Number:
Guardian’s E-mail Address:
(c) Initial Guardianship Plan for Adult.
In the Circuit Court of the
Judicial
Circuit,
in and for
County, Florida
Probate Division
Case No.
In Re: Guardianship of
Respondent’s Name
Person with Developmental Disability
INITIAL GUARDIANSHIP PLAN
(Initial Report of Guardian/Guardian Advocate)
.....(Guardian’s name)....., the guardian of the person/guardian advocate
of .....(ward’s name)....., the ward, submits the following initial plan:
During the period beginning .....(beginning date)....., and ending on
.....(ending date)....., the guardian proposes the following plan for the benefit of
the ward.
1. The medical, mental, or personal care services for the welfare of
the ward that will be provided during the upcoming year are:
Provider Type of Service to be Provided
2. The social and personal services to be provided for the welfare of
the ward during the upcoming year are:
3. The place and kind of residential setting best suited for the needs
of the ward is:
4. Describe the health and accident insurance and any other private
or governmental benefits to which the ward may be entitled to meet any part of
the costs of medical, mental health, or related services provided to the ward:
5. The physical and mental examinations necessary to determine the
ward’s medical, and mental health treatment needs are:
6. The guardian/guardian advocate hereby attests that the
guardian/guardian advocate has consulted with the ward and, to the extent
reasonable, honored the ward’s wishes consistent with the rights retained by
the ward under the plan, and to the maximum extent reasonable, the plan is in
accordance with the wishes of the ward.
7. This initial plan does not restrict the physical liberty of the ward
more than is reasonably necessary to protect the ward from serious physical
injury, illness, or disease and provides the ward with medical care and mental
health treatment for the ward’s physical and mental health.
(Please use additional sheets if necessary.)
8. The following is a list of preexisting orders not to resuscitate,
health care surrogate decision, living will, or anatomical gift.
Steps Taken
to Locate
Suspended by any
Court (Yes or Preexisting
# Title Date No) Document
1.
2.
3.
(Please use additional sheets if necessary.)
Under penalties of perjury, I declare that I have completed and read
the foregoing, and the facts set forth are true, to the best of my
knowledge and belief.
Signed on .....(date)......
[A certificate of service is required unless ward has been declared totally
incapacitated.]
[I certify that the foregoing document has been furnished to .....(name,
address used for service, mailing address, and e-mail address)..... by .....(e-
mail) (delivery) (mail) (fax)..... on .....(date)…...]
Guardian’s Signature
Guardian’s Printed Name:
Guardian’s Address:
Guardian’s Phone Number:
Guardian’s E-mail Address:
(d) Annual Guardianship Plan for Adult.
In the Circuit Court of the
Judicial
Circuit,
in and for
County, Florida
Probate Division
Case No.
In Re: Guardianship of
Respondent’s Name
Person with Developmental Disability
ANNUAL GUARDIANSHIP PLAN OF GUARDIAN/
GUARDIAN ADVOCATE OF THE PERSON
.....(Guardian’s name)....., the guardian of the person/guardian advocate
of .....(ward’s name)....., the ward, submits the following annual plan for the
period beginning .....(beginning date)..... ending .....(ending date)......
1. The ward’s address at the time of filing this plan is:
2. During the prior 12 months, the ward resided or was maintained
at (include dates, names, addresses, and length of stay at each location):
Date Name Address Length of stay
3. The residential setting best suited for the current needs of the
ward is (Check 1):
( ) a. group home;
( ) b. assisted living;
( ) c. nursing home;
( ) d. live with parents;
( ) e. at ward’s private residence; or
( ) f. other:
4. Plans for ensuring that the ward is in the best residential setting to
meet the ward’s needs during the coming year are as follows:
5. The following is a list of any medical treatment given to the ward
during the preceding year:
Date Provider Treatment provided
6. Attached is a report of a physician who examined the ward no
more than 90 days before the end of the report period, including that
physician’s evaluation of the ward’s condition and a statement of the current
level of capacity of the ward.
7. The plan for provision of medical, dental, mental health, and
rehabilitative services (for example, occupational therapy, physical therapy,
speech therapy, applied behavioral analysis) in the coming year is:
Date Provider Service provided
8. The following information is submitted concerning the social
condition of the ward:
a. The ward is currently using the following social and personal
services (include name, services rendered, and address of each provider),
including any groups in which the ward is participating:
Date Provider Service provided
b. The following is a statement of the social skills of the ward,
including how well the ward maintains interpersonal relationships with others:
c. The following is a description of the social needs of the ward,
if any:
9. The following is a summary of activities during the preceding year
designed to increase the capacity of the ward, including involvement in groups
or group activities:
10. Is the ward now capable of having some or all of the ward’s rights
restored?
( ) If yes, identify the rights that should be restored:
11. Do you plan to seek the restoration of any rights to the ward?
( ) If yes, identify the rights that you are seeking to be restored:
12. This plan has or has not been reviewed with
the ward.
(Please use additional sheets where necessary.)
13. The following is a list of preexisting orders not to resuscitate,
health care surrogate designation, living will, or anatomical gift.
Steps Taken
to Locate
Suspended by any
Court? (Yes or Preexisting
# Title Date No) Document
1.
2.
3.
(Please use additional sheets if necessary.)
Under penalties of perjury, I declare that I have completed and read
the foregoing, and the facts set forth are true, to the best of my
knowledge and belief.
Signed on .....(date)......
[A certificate of service is required unless ward has been declared totally
incapacitated.]
[I certify that the foregoing document has been furnished to .....(name,
address used for service, mailing address, and e-mail address)..... by .....(e-
mail) (delivery) (mail) (fax)..... on .....(date).…..]
Guardian’s Signature
Guardian’s Printed Name:
Guardian’s Address:
Guardian’s Phone Number:
Guardian’s E-mail Address:
If the guardian is represented by counsel, the attorney must comply with
Florida Rule of General Practice and Judicial Administration 2.515 (every
document of a party represented by an attorney must be signed by at least 1
attorney of record).
(e) Physician’s Report.
In the Circuit Court of the
Judicial
Circuit,
in and for
County, Florida
Probate Division
Case No.
In Re: Guardianship of
Respondent’s Name
Person with Developmental Disability
PHYSICIAN’S REPORT
(Required by section 744.3675, Florida Statutes)
1. Name of Physician:
Address:
2. Name of ward:
3. Date of examination:
4. Purpose of examination:
a. Regular checkup:
b. Treatment for:
5. Evaluation of ward’s condition: (Specify mental and physical
condition at time of examination)
6. Description of ward’s capacity to live independently:
7. The ward does does not continue to need assistance of a
guardian.
8. Is the ward capable of being restored to capacity at this time?
Yes No
Are there any rights that can be restored at this time? Check any rights that
can be restored:
( ) a. to marry;
( ) b. to vote;
( ) c. to personally apply for government benefits;
( ) d. to have a driver license;
( ) e. to travel;
( ) f. to seek or retain employment;
( ) g. to contract;
( ) h. to sue and defend lawsuits;
( ) i. to apply for government benefits;
( ) j. to manage property or to make any gift or disposition
of property;
( ) k. to determine the ward’s residence;
( ) l. to consent to medical and mental health treatment; or
( ) m. to make decisions about the ward’s social environment
or other social aspects of the ward’s life.
9. Date of this report:
10. Signature of physician completing this report:
APPENDIX A
INSTRUCTIONS TO GUARDIANS AND GUARDIAN ADVOCATES FOR FILING
ANNUAL PLANS
1. Fill in the name of the county in which the case is filed on the
second blank line at the top where it reads “IN AND FOR
COUNTY.”
2. Print the name of the ward on the line just below the “In Re:
Guardianship of” caption.
3. Put the case number in the space marked “CASE NO.” in the upper
right-hand corner (same as court file number).
4. On the first blank line after the title of the document (Annual
Plan), print the guardian’s name.
5. On the next blank line, print the ward’s name.
6. Write in the dates for the period of time of the plan. This period
should end on the last day of the month of the month you were appointed and
begin a full year before that. If you do not know your plan period, please see
the chart below. Please call the clerk’s office or the appropriate court staff in
the county in which you are filing, if you cannot determine the plan period after
reviewing the chart.
7. Type or print answers to all of the questions on the plan. If the
question does not apply to your ward’s circumstances, write in the phrase “not
applicable.” Fill in all the blanks. If your ward has a habilitation plan (produced
by the social worker or the Florida Department of Children and Families) and it
has changed, please provide a copy of the habilitation plan as an attachment to
the annual plan. If the habilitation plan has not changed then do not file a
copy.
8. In paragraph 9, if your ward participates in groups, include that
information in this paragraph.
9. Sign your name, and print your name, address, e-mail address,
and phone number where indicated. If there are co-guardian advocates, both
must sign the plan.
10. Make a copy of the plan for your records in the event there is a
problem and work from it for next year’s plan. Make a copy of any attachments
to the plan, as well.
11. Mail or hand deliver the original plan to the Clerk of Court of the
county in which the case is filed. You MUST also send a copy of the plan to
your attorney, if you have an attorney, so that the attorney will know that you
have filed the plan and will have a copy of the plan in case there is a problem.
APPENDIX B
ANNUAL ACCOUNTING AND PLAN DATES
(IF FISCAL YEAR REPORT PERIOD)
Month Letters Report Begin Report End Report
Due
Signed Date Date Date
January February 1 January 31 May 1
February March 1 February 28 June 1
March April 1 March 31 July 1
April May 1 April 30 August 1
May June 1 May 31 September
1
June July 1 June 30 October 1
July August 1 July 31 November
1
August September 1 August 31 December
1
September October 1 September 30 January 1
October November 1 October 31 February 1
November December 1 November 30 March 1
December January 1 December 31 April 1
PLANS
(a) Initial Guardianship Plan for Minor.
In the Circuit Court of the
Judicial
Circuit,
in and for
County, Florida
Probate Division
Case No.
In Re: Guardianship of
Minor Ward
INITIAL GUARDIANSHIP PLAN FOR MINOR
.....(Guardian’s name)....., the guardian of the person of .....(ward’s
name)....., submits the following annual plan for the period beginning on
.....(beginning date)..... and ending on .....(ending date)....., for the benefit of the
ward.
1. The ward’s address at the time of filing this plan is:
2. The medical, dental, mental, or personal care services for the
welfare of the ward that will be provided during the upcoming year are:
Provider Type of Service to be Provided
3. The social and personal services to be provided for the welfare of
the ward during the upcoming year are:
4. The place and kind of residential setting best suited for the needs
of the ward is:
5. The physical and/or mental examinations necessary to determine
the ward’s medical, dental, and mental health treatment needs are:
6. Education of the ward:
Name and address of the school the ward will attend:
Grade level of ward:
Description of classes the ward will attend:
7. Consulting with ward (Check 1):
( ) a. The ward is under age 14;
OR
( ) b. The guardian attests that the guardian has consulted
with the ward (if ward is 14 years of age or older) and, to the extent reasonable,
honored the ward’s wishes consistent with the rights retained by the ward
under the plan, and to the maximum extent reasonable, the plan is in
accordance with the wishes of the ward.
8. This initial plan does not restrict the physical liberty of the ward
more than is reasonably necessary to protect the ward from serious physical
injury, illness, or disease and provides the ward with medical care and mental
health treatment for the ward’s physical and mental health.
(Please use additional sheets if necessary.)
Under penalties of perjury, I declare that I have completed and read
the foregoing, and the facts set forth are true, to the best of my
knowledge and belief.
Signed on .....(date)......
[A certificate of service is required if ward is 14 years of age or older.]
[I certify that the foregoing document has been furnished to .....(name,
address used for service, mailing address, and e-mail address)..... by (e-mail)
(delivery) (mail) (fax) on .....(date)…...]
Guardian’s Signature
Guardian’s Printed Name:
Guardian’s Address:
Guardian’s Phone Number:
Guardian’s E-mail Address:
If the guardian is represented by counsel, the attorney must comply with
Florida Rule of General Practice and Judicial Administration 2.515.
(b) Annual Guardianship Plan for Minor.
In the Circuit Court of the
Judicial
Circuit,
in and for
County, Florida
Probate Division
Case No.
In Re: Guardianship of
Minor Ward
ANNUAL GUARDIANSHIP PLAN FOR MINOR
.....(Guardian’s name)....., the guardian of the person of .....(ward’s
name)....., submits the following annual plan for the period beginning on
.....(beginning date)..... and ending on .....(ending date)......
1. The ward’s address at the time of filing this plan is:
. During the prior 12 months, the ward resided at (include dates, names,
addresses, and length of stay at each location):
Date Name Address Length of stay
2. List any professional treatment (medical or dental) given to the
ward during the prior 12 months:
Date Provider Treatment provided
Date Provider Treatment provided
3. A report from the physician who examined the ward no more than
180 days before the beginning of the applicable reporting period that contains
an evaluation of the ward’s physical and mental conditions has been filed with
this plan. [See subdivision (e) of this rule for a format for a physician’s report.]
4. The plan for providing medical or dental services in the coming
year:
5. A summary of the ward’s school progress report:
6. A description of the ward’s social development, including how well
the ward communicates and maintains interpersonal relationships:
7. The social needs of the ward are:
8. Consulting with ward (Check 1):
( ) a. The ward is under age 14;
OR
( ) b. The guardian attests that the guardian has consulted
with the ward (if ward is 14 years of age or older) and, to the extent reasonable,
honored the ward’s wishes consistent with the rights retained by the ward
under the plan, and to the maximum extent reasonable, the plan is in
accordance with the wishes of the ward.
(Please use additional sheets if necessary.)
Under penalties of perjury, I declare that I have completed and read
the foregoing, and the facts set forth are true, to the best of my
knowledge and belief.
Signed on .....(date)......
[A certificate of service is required if ward is 14 years of age or older.]
[I certify that the foregoing document has been furnished to .....(name,
address used for service, mailing address, and e-mail address)..... by .....(e-
mail) (delivery) (mail) (fax)..... on .....(date)…...]
Guardian’s Signature
Guardian’s Printed Name:
Guardian’s Address:
Guardian’s Phone Number:
Guardian’s E-mail Address:
(c) Initial Guardianship Plan for Adult.
In the Circuit Court of the
Judicial
Circuit,
in and for
County, Florida
Probate Division
Case No.
In Re: Guardianship of
Respondent’s Name
Person with Developmental Disability
INITIAL GUARDIANSHIP PLAN
(Initial Report of Guardian/Guardian Advocate)
.....(Guardian’s name)....., the guardian of the person/guardian advocate
of .....(ward’s name)....., the ward, submits the following initial plan:
During the period beginning .....(beginning date)....., and ending on
.....(ending date)....., the guardian proposes the following plan for the benefit of
the ward.
1. The medical, mental, or personal care services for the welfare of
the ward that will be provided during the upcoming year are:
Provider Type of Service to be Provided
2. The social and personal services to be provided for the welfare of
the ward during the upcoming year are:
3. The place and kind of residential setting best suited for the needs
of the ward is:
4. Describe the health and accident insurance and any other private
or governmental benefits to which the ward may be entitled to meet any part of
the costs of medical, mental health, or related services provided to the ward:
5. The physical and mental examinations necessary to determine the
ward’s medical, and mental health treatment needs are:
6. The guardian/guardian advocate hereby attests that the
guardian/guardian advocate has consulted with the ward and, to the extent
reasonable, honored the ward’s wishes consistent with the rights retained by
the ward under the plan, and to the maximum extent reasonable, the plan is in
accordance with the wishes of the ward.
7. This initial plan does not restrict the physical liberty of the ward
more than is reasonably necessary to protect the ward from serious physical
injury, illness, or disease and provides the ward with medical care and mental
health treatment for the ward’s physical and mental health.
(Please use additional sheets if necessary.)
8. The following is a list of preexisting orders not to resuscitate,
health care surrogate decision, living will, or anatomical gift.
Steps Taken
to Locate
Suspended by any
Court (Yes or Preexisting
# Title Date No) Document
1.
2.
3.
(Please use additional sheets if necessary.)
Under penalties of perjury, I declare that I have completed and read
the foregoing, and the facts set forth are true, to the best of my
knowledge and belief.
Signed on .....(date)......
[A certificate of service is required unless ward has been declared totally
incapacitated.]
[I certify that the foregoing document has been furnished to .....(name,
address used for service, mailing address, and e-mail address)..... by .....(e-
mail) (delivery) (mail) (fax)..... on .....(date)…...]
Guardian’s Signature
Guardian’s Printed Name:
Guardian’s Address:
Guardian’s Phone Number:
Guardian’s E-mail Address:
(d) Annual Guardianship Plan for Adult.
In the Circuit Court of the
Judicial
Circuit,
in and for
County, Florida
Probate Division
Case No.
In Re: Guardianship of
Respondent’s Name
Person with Developmental Disability
ANNUAL GUARDIANSHIP PLAN OF GUARDIAN/
GUARDIAN ADVOCATE OF THE PERSON
.....(Guardian’s name)....., the guardian of the person/guardian advocate
of .....(ward’s name)....., the ward, submits the following annual plan for the
period beginning .....(beginning date)..... ending .....(ending date)......
1. The ward’s address at the time of filing this plan is:
2. During the prior 12 months, the ward resided or was maintained
at (include dates, names, addresses, and length of stay at each location):
Date Name Address Length of stay
3. The residential setting best suited for the current needs of the
ward is (Check 1):
( ) a. group home;
( ) b. assisted living;
( ) c. nursing home;
( ) d. live with parents;
( ) e. at ward’s private residence; or
( ) f. other:
4. Plans for ensuring that the ward is in the best residential setting to
meet the ward’s needs during the coming year are as follows:
5. The following is a list of any medical treatment given to the ward
during the preceding year:
Date Provider Treatment provided
6. Attached is a report of a physician who examined the ward no
more than 90 days before the end of the report period, including that
physician’s evaluation of the ward’s condition and a statement of the current
level of capacity of the ward.
7. The plan for provision of medical, dental, mental health, and
rehabilitative services (for example, occupational therapy, physical therapy,
speech therapy, applied behavioral analysis) in the coming year is:
Date Provider Service provided
8. The following information is submitted concerning the social
condition of the ward:
a. The ward is currently using the following social and personal
services (include name, services rendered, and address of each provider),
including any groups in which the ward is participating:
Date Provider Service provided
b. The following is a statement of the social skills of the ward,
including how well the ward maintains interpersonal relationships with others:
c. The following is a description of the social needs of the ward,
if any:
9. The following is a summary of activities during the preceding year
designed to increase the capacity of the ward, including involvement in groups
or group activities:
10. Is the ward now capable of having some or all of the ward’s rights
restored?
( ) If yes, identify the rights that should be restored:
11. Do you plan to seek the restoration of any rights to the ward?
( ) If yes, identify the rights that you are seeking to be restored:
12. This plan has or has not been reviewed with
the ward.
(Please use additional sheets where necessary.)
13. The following is a list of preexisting orders not to resuscitate,
health care surrogate designation, living will, or anatomical gift.
Steps Taken
to Locate
Suspended by any
Court? (Yes or Preexisting
# Title Date No) Document
1.
2.
3.
(Please use additional sheets if necessary.)
Under penalties of perjury, I declare that I have completed and read
the foregoing, and the facts set forth are true, to the best of my
knowledge and belief.
Signed on .....(date)......
[A certificate of service is required unless ward has been declared totally
incapacitated.]
[I certify that the foregoing document has been furnished to .....(name,
address used for service, mailing address, and e-mail address)..... by .....(e-
mail) (delivery) (mail) (fax)..... on .....(date).…..]
Guardian’s Signature
Guardian’s Printed Name:
Guardian’s Address:
Guardian’s Phone Number:
Guardian’s E-mail Address:
If the guardian is represented by counsel, the attorney must comply with
Florida Rule of General Practice and Judicial Administration 2.515 (every
document of a party represented by an attorney must be signed by at least 1
attorney of record).
(e) Physician’s Report.
In the Circuit Court of the
Judicial
Circuit,
in and for
County, Florida
Probate Division
Case No.
In Re: Guardianship of
Respondent’s Name
Person with Developmental Disability
PHYSICIAN’S REPORT
(Required by section 744.3675, Florida Statutes)
1. Name of Physician:
Address:
2. Name of ward:
3. Date of examination:
4. Purpose of examination:
a. Regular checkup:
b. Treatment for:
5. Evaluation of ward’s condition: (Specify mental and physical
condition at time of examination)
6. Description of ward’s capacity to live independently:
7. The ward does does not continue to need assistance of a
guardian.
8. Is the ward capable of being restored to capacity at this time?
Yes No
Are there any rights that can be restored at this time? Check any rights that
can be restored:
( ) a. to marry;
( ) b. to vote;
( ) c. to personally apply for government benefits;
( ) d. to have a driver license;
( ) e. to travel;
( ) f. to seek or retain employment;
( ) g. to contract;
( ) h. to sue and defend lawsuits;
( ) i. to apply for government benefits;
( ) j. to manage property or to make any gift or disposition
of property;
( ) k. to determine the ward’s residence;
( ) l. to consent to medical and mental health treatment; or
( ) m. to make decisions about the ward’s social environment
or other social aspects of the ward’s life.
9. Date of this report:
10. Signature of physician completing this report:
APPENDIX A
INSTRUCTIONS TO GUARDIANS AND GUARDIAN ADVOCATES FOR FILING
ANNUAL PLANS
1. Fill in the name of the county in which the case is filed on the
second blank line at the top where it reads “IN AND FOR
COUNTY.”
2. Print the name of the ward on the line just below the “In Re:
Guardianship of” caption.
3. Put the case number in the space marked “CASE NO.” in the upper
right-hand corner (same as court file number).
4. On the first blank line after the title of the document (Annual
Plan), print the guardian’s name.
5. On the next blank line, print the ward’s name.
6. Write in the dates for the period of time of the plan. This period
should end on the last day of the month of the month you were appointed and
begin a full year before that. If you do not know your plan period, please see
the chart below. Please call the clerk’s office or the appropriate court staff in
the county in which you are filing, if you cannot determine the plan period after
reviewing the chart.
7. Type or print answers to all of the questions on the plan. If the
question does not apply to your ward’s circumstances, write in the phrase “not
applicable.” Fill in all the blanks. If your ward has a habilitation plan (produced
by the social worker or the Florida Department of Children and Families) and it
has changed, please provide a copy of the habilitation plan as an attachment to
the annual plan. If the habilitation plan has not changed then do not file a
copy.
8. In paragraph 9, if your ward participates in groups, include that
information in this paragraph.
9. Sign your name, and print your name, address, e-mail address,
and phone number where indicated. If there are co-guardian advocates, both
must sign the plan.
10. Make a copy of the plan for your records in the event there is a
problem and work from it for next year’s plan. Make a copy of any attachments
to the plan, as well.
11. Mail or hand deliver the original plan to the Clerk of Court of the
county in which the case is filed. You MUST also send a copy of the plan to
your attorney, if you have an attorney, so that the attorney will know that you
have filed the plan and will have a copy of the plan in case there is a problem.
APPENDIX B
ANNUAL ACCOUNTING AND PLAN DATES
(IF FISCAL YEAR REPORT PERIOD)
Month Letters Report Begin Report End Report
Due
Signed Date Date Date
January February 1 January 31 May 1
February March 1 February 28 June 1
March April 1 March 31 July 1
April May 1 April 30 August 1
May June 1 May 31 September
1
June July 1 June 30 October 1
July August 1 July 31 November
1
August September 1 August 31 December
1
September October 1 September 30 January 1
October November 1 October 31 February 1
November December 1 November 30 March 1
December January 1 December 31 April 1