GC-334 Ex Parte Order Re Completion of Capacity

GC-334 Ex Parte Order Re Completion of Capacity Declaration—HIPAA Effective: January 1,…¶

Source: https://www.courts.ca.gov/documents/gc334.pdf

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GC-334 ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY NAME: FIRM NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE NO.: FAX NO.: EMAIL ADDRESS: ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NUMBER: CONSERVATORSHIP OF THE PERSON ESTATE OF

(name): CONSERVATORSHIP PETITION HEARING DATE: PROPOSED CONSERVATEE

TIME: DEPT.:

EX PARTE ORDER RE COMPLETION OF CAPACITY DECLARATION—HIPAA*

Attached to this order is a Confidential Capacity Assessment and Declaration—Probate Conservatorship (form GC-335) and an Everyday Activities Attachment to Confidential Capacity Assessment and Declaration—Probate Conservatorship (form GC-335A) (the Declaration).
Applicant (name): having applied for an order authorizing the declarant(s) named in item 5 to complete, sign, and return the Declaration for the purpose specified in item 6, and good cause appearing:

THE COURT FINDS 3. Notice of the hearing on the application should be dispensed with and the application should be granted. 4. A petition for the appointment of a conservator has been filed in this proceeding by (name of petitioner):

This petition is set for hearing on (date): at (time): in Dept.: Rm.: 5. Declarant (name each):

has been requested to complete and sign the Declaration for the purpose specified in item 6. 6. Petitioner proposes to use the Declaration to provide evidence to support (check all that apply): a. A finding that the proposed conservatee should be excused from attending the hearing on the petition. b. A request for exclusive authority to consent to medical treatment for the proposed conservatee. c. A request for authority to make placement and medication decisions related to treatment of a major neurocognitive disorder (including dementia). d. The appointment of a conservator of the estate. e. Other (specify):

The federal Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191).

Judicial Council of California, courts.ca.gov GC-334, Page 1 of 2Rev. January 1, 2026, Mandatory Form Ex Parte Order re Completion of Prob. Code, §§ 1801, 1872, 1890, 2356.5; Civ. Code, §§ 56.10, 56.13; 45 C.F.R. §§ 160, 164 Capacity Declaration—HIPAA

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GC-334 CONSERVATORSHIP OF (name): CASE NUMBER:

PROPOSED CONSERVATEE

THE COURT ORDERS 7. Notice of hearing on the application is dispensed with.

Each declarant named below is authorized to complete, sign, and deliver to the attorney or other person whose address appears at the top of page 1 of this order the original of the Declaration, consisting of: a. Confidential Capacity Assessment and Declaration—Probate Conservatorship (form GC-335) (name each authorized declarant):

b. and Everyday Activities Attachment to Confidential Capacity Assessment and Declaration—Probate Conservatorship (form GC-335A) (name each authorized declarant): regarding (name of proposed conservatee): to enable the Court to determine whether the proposed conservatee should be excused from attending the hearing on the appointment of a conservator or the proposed conservator should be granted certain powers over the person or estate of the proposed conservatee.
Use of the Declaration is governed by the disclosure safeguards in the regulations of the federal Department of Health and Human Services (45 C.F.R. §§ 160 & 164) under HIPAA, and no use other than what is permitted in those regulations is permitted by this order.
The completed and signed original of the Declaration must be returned to the attorney or other person whose address appears at the top of this order within 15 days after its receipt by the declarant authorized to complete and sign it.
Other orders (specify):

Date:

JUDICIAL OFFICER

CERTIFICATION

I certify that this document, including any attachments, is a correct copy of the original on file in my office.

Date: Clerk, by , Deputy

(SEAL)

Rev. January 1, 2026 Ex Parte Order re Completion of GC-334, Page 2 of 2 Capacity Declaration—HIPAA For your protection and privacy, please press the Clear button after you have printed the form. Print Save Clear

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