CI revised 1 31 14 1

7eb2a28f3df60581e3f67bd8d3edaf0e5423092a

California Superior Local Rules

CI revised 1 31 COURT INVESTIGATOR'S OFFICE BERKELEY COURTHOUSE MARTIN LUTHER KING, JR.

WAY BERKELEY, CA SUPERIOR COURT - ALAMEDA COUNTY STATUS REPORT ON CONSERVATEE (Local Court Rule 7.870) In the Matter of the Conservatorship of: ) PROBATE NUMBER: ) ) HEARING DATE: ,Conservatee ) THIS IS A CONFIDENTIAL REPORT CI revised 1 31 CONFIDENTIAL STATUS REPORT Name of Conservatee: _____________________________________________ Probate No.: ___________________ Current Residence: _____________________________________________________________________________ _______________________________________________________________Phone:__________________________ Please provide the following information about the conservatee. 1.

Current Health Status -

a) Doctor's Name: _________________________________Date of last appointment: ___________________

b) Describe conservatee’s current health status, including diagnoses. _____________________________ __________________________________________________________________________________________

c) Describe any significant health changes since the last review. __________________________________ __________________________________________________________________________________________ 2. Current Function Level -

a) Describe conservatee's ability to care for self _________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

b) Describe conservatee’s communication/understanding level ___________________________________ __________________________________________________________________________________________

c) Describe any significant changes in the conservatee’s ability to care for self or communicate/understand since the last review. _________________________________________________________________________________________ _________________________________________________________________________________________ 3. Current General Well Being -

a) Describe the current living situation (own home/board & care/skilled nursing/etc.) ________________________________________________________________________________________

b) If the conservatee lives at home, does he/she receive IHSS benefits? ___________________________ If, yes, name of care provider__________________________________________Phone________________ Name of social worker at IHSS _________________________________________Phone_______________

c) Describe any plans to change the living situation _____________________________________________ ________________________________________________________________________________________

d) Date of last visit by conservator ____________________________________________________________ Frequency of visits by conservator ___________________________________________________________ Does the conservatee have other visitors? ____________________________________________________ 4. Current estate situation -

a) Present market value ____________________________________________________________________

b) Adequate to meet needs of the conservatee ________________________________________________ Explain_________________________________________________________________________________

c) If you plan to make significant changes in the way the estate is being handled, please describe them. (e.g., a reverse annuity mortgage in order to keep the conservatee in own home). ____________________________________________________________________________________ 5. Name and phone no. of Day Program, if applicable____________________________________________ 6.

Conservator’s comments - Please indicate any unusual problems/successes you wish the court to be aware of that occurred since the last review. __________________________________________ __________________________________________________________________________________________ I declare under penalty of perjury that the foregoing is true and correct.

Date signed: ______________________________ __________________________________________ Conservator’s Signature _________________________________________________________________________________________ Mailing Address City, State, Zip Code _______________________________________________ Telephone Number/Email address *Attach additional pages if necessary. CONFIDENTIAL STATUS REPORT

Document details

Collection	California Superior Local Rules
Citation	7eb2a28f3df60581e3f67bd8d3edaf0e5423092a
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	7eb2a28f3df60581e3f67bd8d3edaf0e5423092a

Source file is stored in the law ingest library (pdf).