IN THE SUPERIOR COURT FOR THE STATE OF ALASKA

AT ____________________

In the Matter of the Protective Proceedings of:	)

)

)

)	Case No:

)

Protected Person.	)	COURT VISITOR’S

)	THREE-YEAR REPORT

I,	, was appointed as the court visitor for the guardianship or conservatorship case listed above. I hereby submit this report under AS 13.26.276 and/or AS 13.26.515(b) and (d).

I request that a judge review the recommendations in section G of this report.

No changes to the current order recommended.

Reporting Period

Last visitor report filed:	This report’s due date:

Dates reviewed in this report:

B. Background Information

Did you review the current order?

Yes, I reviewed the order dated	.

No, because:

Did you review the last Court Visitor Report?

Yes, I reviewed the report dated	.

No, because:

What are the guardian’s or conservator’s duties?

Full guardian (including conservator authority) Full conservator only

Partial guardian ( with without conservator powers) Partial conservator

If partial guardian or conservator, list areas of authority:

4.	Are there any co-guardians or co-conservators? No Yes, list names and areas of authority:

5.	Are there any special provisions in the order (e.g., room and board authorization, authorization for the guardian to be a Personal Care Assistant (PCA), co-guardians with different areas of authority, etc.)?

No Yes, please describe the special provisions:

6.	Is the guardian or conservator following the special provisions correctly?

N/A – no special provisions Yes No, please describe:

7.	List persons you contacted or attempted to contact during your review, including the protected person and the guardian or conservator.

Role	Name	Address	Phone/Email	How was contact made?
Protected Person
Guardian/ Conservator
Co-Guardian/ Conservator
Care Coordinator/ Manager
Assisted Living Admin/Staff
PCA/Waiver Provider

8.	Do the opinions of the individuals contacted support the conclusions of this report?

C. Summary Information about the Guardianship or Conservatorship

[Provide a brief description for each of the following that are applicable. Include in each section whether the protected person continues to need a guardian and/or conservator in that area of the protected person’s life.]

1.	Housing.

[Describe what type of housing the protected person lives in, and the person’s access to meals, clothing, house-cleaning, transportation, and other basic necessities.]

2.	Medical and Mental Health Care.

[Describe current diagnoses, major health events or changes, emotional status and behaviors, and a brief description of treatments and/or plans to address any ongoing medical or mental health issues. If the protected person needs assistance with daily activities, describe how that assistance is being provided.]

Has there been a change in diagnoses? No Yes; please describe the change:

3.	Personal Care, School, and Work Activities.

[Describe any employment, schooling, or job training the protected person is currently engaged in. Describe recreational and social activities the protected person regularly engages in.]

Contacts.

[Describe the contacts the guardian or conservator has had with the protected person, including in-person, telephonic, written, or third-party contacts. Include whether there are any complaints about contact.]

5.	Community Resources.

Please check all services that are being provided to the protected person that are not already covered in sections 1 through 4.

Funding Program(s)	Assisted Living

Case Management/Care Coordination	In-home services/PCA

Other Service/Program:

Briefly describe these programs and what services they provide to the protected person:

Is the guardian or conservator providing any of these services to the protected person?

No Yes; which services?

6.	Significant Actions.

[Describe any significant actions (for example, changes to housing, work/school, medical care, etc.) that the guardian or conservator has taken since the last visitor’s report.]

7.	Assessment of Guardianship/Conservatorship.

What is the protected person’s opinion of the guardianship or conservatorship?

[Please address each of the applicable categories in sections 1 through 6. If you don’t know the person’s opinion, or the person is unable to express an opinion, explain below.]

Do you have, or has anyone else expressed, any concerns with the guardianship or conservatorship services being provided to the protected person?

Changes in Guardianship or Conservatorship

Since the court’s most recent appointment order was issued, are there any changes in the protected person’s ability to manage his/her/their own affairs?

Are there any changes with the guardian’s or conservator’s qualifications to serve?

[Please check Courtview for recent court cases of concern. Note: If this is a professional guardian or conservator, indicate whether that person’s professional license is in good standing and whether fees are being charged appropriately.]

E. Financial Information

The guardianship reviewed in this report does not include conservator authority.

[Skip to section F.]

Income.

Description	Value at Last 3-Year Report	Value in 20	Value in 20	Value in 20
Wages/Salary:
Social Security Benefits:
Dividends/Interest:
Public Assistance:
Veterans Benefits:
Senior Care Benefit:
Alaska PFD
Native Corporation Dividend:
Rental Income:
Pension:
Annuities:

TOTAL:

2.	Expenses.

Description	Value at Last 3-Year Report	Value in 20	Value in 20	Value in 20
Nursing/Assisted Living Home:
Room and Board
Rent/Mortgage
Utility:
Utility:
Utility:
Utility:
Transportation:
Medication:
Medical Treatment:
Credit Card: Payments:
Food:
Clothing:
Entertainment:
Travel/Vacation:
Personal Expenses:
Taxes:
Home/Property Maintenance:
Insurance:
Insurance:
Insurance:
Gifts:
Child/Spousal Support:
Fees/Costs Paid to Guardian:
Reimbursements to Guardian:

TOTAL:

3.	Assets.

Description	Value at Last 3-Year Report	Value in 20	Value in 20	Value in 20
Cash on Hand
Regular Bank Account:
Regular Bank Account:
Alaska Native Corp. Div. Account
Retirement Account:
Life Insurance Policy:
Burial Account
Other Account:
Other Account:
Home
Other Real Estate:
Vehicles
Personal Property

TOTAL:

4.	Debts and Liabilities.

Description	Value at Last 3-Year Report	Value in 20	Value in 20	Value in 20
Mortgage on Home
Other Real Estate Debt:
Money Owed to Guardian or Conservator

TOTAL:

Accounting.

Describe how the guardian or conservator tracks income and expenses:

b.	Are financial records and bank statements available for review?

c.	Are there any discrepancies in the accounting or noted in the file?

d.	Do the income and expenses in the annual reports reconcile?

e.	Were there any major changes in the protected person’s financial status?

f.	What documents did you review to ensure appropriate accounting?

g.	Do any providers describe any financial concerns?

Does the protected person receive spending money or allowance?

F. Other Information

1.	Is this an OPA public guardian appointment?

No.	Yes. If yes, are there any alternative guardians or conservators available?

2.	Is there any other information the guardian/conservator, the protected person, or you (the court visitor) think the court should know?

G. Recommendations

1.	Does the protected person still require a guardian or conservator?

[Consider whether a less-restrictive alternative (for example, power of attorney or supported decision-making agreement) may be more appropriate now.]

Yes	No, because:

Does the current guardianship or conservatorship arrangement appear appropriate?

Yes	No, because:

Do financial transactions appear to be in order? Yes No, because:

4.	Did you suggest areas to improve for the guardian or conservator? No Yes

If yes, explain what you suggested and describe any educational materials you provided:

5.	Do you recommend changes to the guardianship or conservatorship order? Are there any issues that need be addressed?

No	Yes, these are my areas of concern and suggested changes to address them:

6.	Do you request judicial review? No Yes, the court should review and address:

7.	Did you discuss this report with the protected person? Yes No

Please describe the details of the discussion, or if you did not have one, why not:

8.	Other recommendations:

Respectfully submitted,

Date	Signature of Court Visitor

Phone Number	Print or Type Name

Email Address	Mailing Address

I certify that on	at	[date/time], a copy of this report was sent to:

Guardian(s):

Conservator(s):

Other(s):

The Protected Person:

was served by mail in person email other method:

was NOT served, because the protected person cannot maintain confidentiality.

Signature of Court Visitor: