Rhode Island General Laws Title 33. Probate Practice and Procedure § 33-15-47. Forms

Current as of January 01, 2024 | Updated by Findlaw Staff

The following forms shall be used for the purposes of this chapter:

STATE OF RHODE ISLAND		PROBATE COURT OF THE
COUNTY OF ____________________		_________________________________
		No. _______________
ESTATE OF _________________________
PERSONAL ESTATE ESTIMATED AT $ __________		CITY/TOWN OF
		______________________________
		20 __________

PETITION FOR LIMITED GUARDIANSHIP OR GUARDIANSHIP
_________________ Petitioner hereby petitions the Probate Court of the city/town of _________________
to appoint a limited guardian/guardian for __________________________________________
who currently resides at ___________________________________________________________,
Address, in the city/town of _______________________________________________________,
and whose date of birth is _________________________________________________________.
Based upon an assessment conducted by ____________________________ on ____________________________
Date, which functional assessment reflects the current level of functioning of _____,
Respondent it has been determined that ______________________________________________
Respondent lacks decision-making ability in one or more of the following areas as indicated:
__________ health care
__________ financial matters
__________ residence
__________ association
__________ other
Regarding each area indicated, please describe the specific assistance needed:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Indicate which of the following less restrictive alternatives to guardianship have been explored and deemed inappropriate as indicated:
__________ Durable Power of Attorney for Health Care
__________ Living Will
__________ Power of Attorney
__________ Durable Power of Attorney
__________ Trusts
__________ Joint Property Arrangements
__________ Representative Payee
__________ Money Management
__________ Single Court Transactions
__________ Government Benefit and Social Service Programs
__________ Housing Options
__________ Supported Decision-Making, see chapter 66.13 of title 42
__________ Other
Please describe the basis for the determination that the alternative will not meet the needs of the respondent for each alternative explored and deemed inappropriate:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
The following individual/agency is willing to serve as guardian:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
Upon information and belief the above individual/agency has:
☐ No conflict of interest that would interfere with guardianship duties.
☐ No criminal background that would interfere with guardianship duties.
☐ The capacity to manage financial resources involved.
☐ The ability to meet requirements of law and unique needs of individual.
☐ Demonstrated willingness to undergo training.
The Respondent has the following heirs at law:
NAME:	RESIDENCE:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________


	Signature

	Name

	Address

	Telephone
Subscribed and sworn to before me as to the truth of the above facts by __________ in __________ on the __________ day of __________, 20 ___.

	Notary Public

	Print Name

	DECREE

	______________________________	______________________________
	Dated	PROBATE JUDGE

This notice should be served at once and returned to the clerk of the court.

NOTICE

STATE OF RHODE ISLAND

BY THE PROBATE COURT OF THE __________ OF __________

BY THE COUNTY OF __________ AND STATE AFORESAID

To ______________________________

Estate or ____________________

Docket No. ____________________

GREETING:

A petition for Limited Guardianship/Guardianship has been filed in the Probate Court of the city/town of ____________________.

____________________________________________ has requested that the Probate Court appoint a limited

Petitioner

guardian/guardian for you.

A hearing regarding this Petition shall be held

On: ______________________________

date

At: ______________________________

time

at the Probate Court for the town of _______________________________________________.

___________________________________________________________________________________________________

Address

___________________________________________________________________________________________________

The Petition requests that the Probate Court consider the qualification of the following individual/agency to serve as your limited guardian/guardian:

___________________________________________________________________________________________________

A guardian ad litem will be appointed by the Probate Court to visit you, explain the process and inform you of your rights.

You have the right to attend the hearing to contest the petition, to request that the powers of the guardian be limited or to object to the appointment of particular individual/agency limited guardian/guardian. If you wish to contest the petition, you have the right to be represented by an attorney, at state expense, if you are indigent.

If the Petition is granted and a limited guardian/guardian is appointed, the Probate Court may give the limited guardian/guardian the power to make decisions about one or more of the following:

Your health care; your money; where you live; and with whom you associate.

Copies of this Notice will be mailed to:

The administrator of any care or treatment facility where you live or receive primary services; your spouse, and heirs at law; any individual or entity known to petitioner to be regularly supplying protection services to you.

CERTIFICATION OF SERVICE
I certify that I hand-delivered and read this Notice to __________ on the __________ day of __________, 20 ___.

	_________________________________________________
	Signature

	_________________________________________________
	Print Name

	_________________________________________________
	Address
CERTIFICATION OF NOTICE
I certify that, as required by Rhode Island General Laws § 33-15-17.1(e), I mailed a copy of this Notice to the following persons, at the addresses listed, on the __________ day of __________, 20 ___.

	_________________________________________________
	Signature

	_________________________________________________
	Print Name

	_________________________________________________
	Address
Subscribed and sworn to before me this __________ day of __________, 20 ___.

	_________________________________________________
	Notary Public
WITNESS
Judge of the Probate Court of the __________ of __________ this __________ day of __________, 20 ___.

	_________________________________________________
	Clerk

	DECISION-MAKING ASSESSMENT TOOL
	Name of Individual being assessed:	Current Address:
	______________________________________________	______________________________________________

		______________________________________________
	Date of Birth:	Permanent Address (if different):
	______________________________________________	______________________________________________

		______________________________________________

Instructions for Completion

This document will be used by a Probate Court to determine whether to appoint a guardian to assist this individual in some or all areas of decision-making.

This document has two parts. Please first complete the part which is right after these instructions, titled Assessment. Then complete the second section, titled Summary.

To a physician completing this document: The individual's treating physician must complete this document. If there is any information of which the treating physician completing this document does not have direct knowledge, he or she is encouraged to make such inquiries of such other persons as are necessary to complete the entire form. Those persons might include other medical personnel such as nurses, or other persons such as family members or social service professionals who are acquainted with the individual. If the physician has received information from others in completing the form, the names of those individuals must be listed on the Summary.

To a non-physician completing this document: Professionals or other persons acquainted with the individual being assessed may also complete this document. If there is information of which a non-physician completing this document does not have knowledge, such non-physician may either leave portions of the document blank, or also make inquiries or do such investigation as is necessary to complete the entire document. Again, the names of any individual from whom information is derived should be listed on the Summary.

The document must be signed and dated by the person completing it. It does not need to be notarized.

A. BIOLOGICAL ASSESSMENT

THE FOLLOWING IS BASED UPON A PHYSICAL EXAMINATION CONDUCTED BY ME ON

_____________________________________________

(DATE)

1. DIAGNOSIS and PROGNOSIS:

2. MEDICATION (PLEASE LIST):

How do the above medications, if any, affect the individual's decision-making ability? Please explain:

3. CURRENT NUTRITIONAL STATUS:

B. PSYCHOLOGICAL ASSESSMENT

1. MEMORY (CIRCLE ONE)

(A) Intact; (B) Mild Impairment; (C) Moderate Impairment; (D) Severe Impairment

2. ATTENTION (CIRCLE ONE)

(A) Intact; (B) Mild Impairment; (C) Shifting/Wandering; (D) Delirium; (E) Unresponsive

3. JUDGMENT (CIRCLE ONE)

(A) Intact; (B) Able to Make Most Decisions; (C) Impaired; (D) Gross Impairment

4. LANGUAGE (CIRCLE ALL THAT APPLY)

(A) Intact (B) Sensory Deficits (Hearing/Speech/Sight)

(D) Completely Unresponsive

5. EMOTION (CIRCLE ALL THAT APPLY)

(A) ANXIETY/DEPRESSION: (1) None (2) History of Anxiety/Depression

(3) Moderate Symptoms of Anxiety/Depression

(4) Severe symptoms with sleep/appetite/energy disturbance

(5) Suicide/Homicidal

(B) OTHER: (1) Suspiciousness/Belligerence/Explosiveness

(2) Delusions/Hallucinations (3) Unresponsive

If you circled any of the above, other than (A) or (1) for any of the above categories, please explain whether the situation is treatable or reversible, and if so, how:

C. SOCIAL ASSESSMENT

1. MOBILITY (CIRCLE ALL THAT APPLY)

(A) Intact/Exercises (B) Drives Car Or Uses Public Transportation

If you circled (C), (D), or (E), is situation treatable or reversible? If so, how?

___________________________________________________________________________________________________

2. SELF CARE (CIRCLE ALL THAT APPLY)

(A) No Assistance Needed;

(B) Requires Assistance with (1) Meals (2) Bathing (3) Dressing (4) Toileting/Feeding

If you circled any of (B), is individual aware that assistance is required? ________

Is individual willing to accept assistance? ________________________________________

Is individual able to arrange for assistance? ______________________________________

3. CARE PLAN MAINTENANCE (CIRCLE ALL THAT APPLY)

(A) No Active Problem; (B) Initiates Problem Identification; (C) Actively Cooperative;

(D) Passively Cooperative; (E) Passively Uncooperative; (F) Actively Uncooperative

4. SOCIAL NETWORK RELATIONSHIPS

(CIRCLE ONE IN (A) AND ONE IN (B))

(A) SUPPORT:

(1) Very Good Supportive Network; (2) Some Support From Family And Friends; (3) No Or Limited Support From Family/Friends; (4) Needs Community Support; (5) Isolated/Homebound

(B) SOCIAL SKILLS:

(1) Very Good Social Skills; (2) Good Social Skills; (3) Interacts With Prompting; (4)

Isolated

D. SUMMARY

I hereby certify that I have reviewed sections A, B, & C attached hereto and based on such assessments that the individual's decision-making ability is as follows:

(1) PLEASE DESCRIBE AS FULLY AS YOU CAN THE INDIVIDUAL'S DECISION-MAKING ABILITY IN EACH OF THE FOLLOWING AREAS:

A. FINANCIAL MATTERS

___________________________________________________________________________________________________

B. HEALTH CARE MATTERS

___________________________________________________________________________________________________

C. RELATIONSHIPS

___________________________________________________________________________________________________

D. RESIDENTIAL MATTERS

___________________________________________________________________________________________________

(2) PLEASE INDICATE YOUR OPINION REGARDING WHETHER THE INDIVIDUAL NEEDS A SUBSTITUTE DECISION-MAKER IN ANY OF THE FOLLOWING AREAS:

(Circle one for each category. If you circle “limited” for any category, please explain.)

(1) FINANCIAL MATTERS	Yes	No	Limited





(2) HEALTH CARE MATTERS	Yes	No	Limited





(3) RELATIONSHIPS	Yes	No	Limited





(4) RESIDENTIAL MATTERS	Yes	No	Limited





(5) OTHER: If there are any other areas in which you think the individual lacks decision-making ability or has limited decision-making ability, please explain.


_______________________________________________________
	Signature
	___________________________________________
	Name (Print or Type)

	___________________________________________
	Title

	___________________________________________
	Date

	___________________________________________
Names and titles of others who assisted in Preparation of This Assessment.





STATE OF RHODE ISLAND	PROBATE COURT OF
THE COUNTY OF ___________________________
Estate of _______________________________	Docket No. __________________

ANNUAL STATUS REPORT

(1) The residence of the ward is ____________________________________________________

(2) The medical condition of the ward is:

(3) I perceive the following changes in the decision making capacity of the ward:

(4) The following is a summary of the actions I have taken and decisions I have made on behalf of the ward during the last year:

(If more space is needed, please attach a supplement).

		_________________________________
		Guardian

		_________________________________
		Date
STATE OF RHODE ISLAND		PROBATE COURT OF
COUNTY OF _________		THE _______________
(Estate Name)
		Probate Court No. __________

REPORT OF THE GUARDIAN AD LITEM
Now comes (Name of Guardian Ad Litem) for (Name of Proposed Ward) and reports that on (Date), I personally visited the proposed ward at (Address). I explained to (Name of Proposed Ward) the following:
* The nature, purpose, and legal effect of the appointment of a guardian;
* The hearing procedure, including, but not limited to, the right to contest the petition, to request limits on the guardian's powers, to object to a particular person being appointed guardian, to be present at the hearing, and to be represented by legal counsel;
* The name of the person known to be seeking appointment as guardian:
Based on such visit and the respondent's reaction thereto, I make the following determination regarding the respondent's desire to be present at the hearing, to contest the petition, to have limits placed on the guardian's powers and respondent's objection, if any, to a particular person being appointed as guardian.

	_________________________________________________________________________________________________

	_________________________________________________________________________________________________

	_________________________________________________________________________________________________

	_________________________________________________________________________________________________
Based on my review of the petition, the decision making assessment tool, my interview with the prospective guardian, my visit with the respondent, and interviews and discussions with other parties, I made the following additional determinations:
Regarding whether the respondent is in need of a guardian of the type prayed for in the petition:

	_________________________________________________________________________________________________

	_________________________________________________________________________________________________

	_________________________________________________________________________________________________

	_________________________________________________________________________________________________
Regarding whether the guardian ad litem has, in the course of fulfilling his or her duties, discovered information concerning the suitability of the individual or entity to serve as such guardian:

	_________________________________________________________________________________________________

	_________________________________________________________________________________________________

	_________________________________________________________________________________________________

	_________________________________________________________________________________________________

		Respectfully submitted,

	Date: ___________________________	________________________________________________
		(Name of Guardian Ad Litem)

Previous Part of Code Next Part of Code

Back to Chapter List

Cite this article: FindLaw.com - Rhode Island General Laws Title 33. Probate Practice and Procedure § 33-15-47. Forms - last updated January 01, 2024 | https://codes.findlaw.com/ri/title-33-probate-practice-and-procedure/ri-gen-laws-sect-33-15-47/

FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.

Was this helpful?

Welcome to FindLaw's Cases & Codes

A free source of state and federal court opinions, state laws, and the United States Code. For more information about the legal concepts addressed by these cases and statutes, visit FindLaw’s Learn About the Law.

Go to Learn About the Law

Latest Blog Posts

Learn About The Law

Get help with your legal needs

FindLaw’s Learn About the Law features thousands of informational articles to help you understand your options. And if you’re ready to hire an attorney, find one in your area who can help.

Go to Learn About the Law

Need to Find an Attorney?

Search our directory by legal issue

Enter information in one or both fields (Required)

Rhode Island General Laws Title 33. Probate Practice and Procedure § 33-15-47. Forms

Search all Rhode Island Codes

Welcome to FindLaw's Cases & Codes

Latest Blog Posts

For Legal Professionals

Learn About The Law

Need to Find an Attorney?