San Francisco — Status Report on Conservatee

Source: https://sf.courts.ca.gov/system/files/general/status-report-conservatee_probate.pdf

CONFIDENTIAL ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR: FOR COURT USE ONLY NAME: FIRM NAME: STREET ADDRESS: CITY AND ZIP CODE: E-MAIL ADDRESS: ATTORNEY FOR (NAME):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN FRANCISCO STREET ADDRESS MAILING ADDRESS: 400 MCALLISTER STREET, ROOM 103 CITY AND ZIP CODE: SAN FRANCISCO, 94102 BRANCH NAME:

CONSERVATOR(S):

CONSERVATORSHIP OF:

☐ PERSON ☐ ESTATE ☐ LIMITED CONSERVATORSHIP
STATUS REPORT ON CONSERVATEE CASE NUMBER:

(Required of all Conservators of the Person one year after appointment and every two years thereafter)

All questions on the form must be completed and answered. If the question or blank does not apply, write “not applicable” or “none”. If you need additional space to fully respond, please note on the form that a separate attachment is being provided and staple the attachment to the form.

I/We am/are the Conservator(s) of the above named Conservatee and my status report is as follows:

Present age of the Conservatee: Date of birth:

PERSONAL NEEDS

Living Arrangement

Current address of Conservatee: Phone:

(include name of facility, if appropriate)

Current living arrangement: ☐ Personal residence ☐ Home of relative ☐ Board and care home ☐ Hotel ☐ Skilled nursing facility ☐ Assisted living ☐ Other:

The Conservatee has been at the present residence since .

PHYSICAL HEALTH

During the past year the Conservatee’s physical condition has ☐ remained about the same ☐ improved (explain) ☐ worsened (explain)

CONFIDENTIAL

STATUS REPORT ON CONSERVATEE

PRB-PCN-005 Rev. May-21-2024

CASE NAME: CASE NUMBER:

During the past year, the Conservatee received the following medical treatment (including check-ups, physical therapy, speech therapy, dental work, or other):

Date Ailment Type of Treatment Medical Provider

MENTAL HEALTH

During the past year, the Conservatee’s mental condition has ☐ remained about the same ☐ improved (explain) ☐ worsened (explain)

During the past year, treatment or evaluation by a mental health therapist, psychologist, or psychiatrist ☐ was provided ☐ was not provided

MEDICATIONS

Name Purpose of Medication Name Purpose of Medication

SOCIAL ACTIVITIES

During the past year, the Conservatee has participated in the following activities: ☐ Outings ☐ Television/Radio ☐ Social (i.e. FaceTime/Skype/Zoom) ☐ Educational ☐ Recreational ☐ Unwilling to participate ☐ Unable to participate ☐ Other (i.e. reading material) Describe

Name of current activity program: Address: Phone: Name of Social Worker: Phone: Day and Hours of Attendance:

Name of Regional Center (if applicable): Name of Social Worker: Phone:

CONFIDENTIAL

STATUS REPORT ON CONSERVATEE

PRB-PCN-005 Rev. May-21-2024

CASE NAME: CASE NUMBER:

VISITATIONS

During the past year, I visited the Conservatee as follows:

Dates of Visits Dates of Visits

SPECIAL PROBLEMS

Explain how you have addressed any special needs or problems raised by the Court Investigator, the Court, or other interested persons.

COMMENTS

Date: Date:

Attorney Conservator(s)

NOTE: ONLY ONE SIGNATURE IS REQUIRED.

CONFIDENTIAL

STATUS REPORT ON CONSERVATEE

PRB-PCN-005 Rev. May-21-2024