Form 6-17

[Caption. See § 3 of the Introduction in this manual.]

Order Appointing Guardian Ad Litem

On [date] the Court considered the necessity for the appointment of a guardian ad litem under section 1054.051 of the Texas Estates Code. The Court finds that it is necessary and proper to appoint a guardian ad litem to represent and protect the best interests of the incapac­itated person, [name of ward].

IT IS ORDERED that [name of guardian ad litem] [, an attorney licensed to practice before this Court,] is appointed guardian ad litem to represent and protect the best interests of the incapacitated person, [name of ward], and to report to the Court as necessary to enable the Court to determine what action will be in the best interests of [name of ward].

IT IS FURTHER ORDERED that the guardian ad litem be entitled to reasonable com­pensation for [his/her] services in an amount to be set by the Court to be taxed as part of the costs of these proceedings and ordered paid in accordance with the applicable law.

IT IS FURTHER ORDERED that, pursuant to Texas Estates Code sections 1054.003 and 1054.004 and HIPAA Regulations (45 C.F.R. section 164.512(e)(1)(i)), the above guard­ian ad litem is authorized and entitled to review and be supplied with copies of all of [name of ward]’s certificates of current physical, medical, and intellectual examinations and have access to all of [name of ward]’s relevant medical, psychological, and intellectual testing records. This means that a health-care organization or physician presented with this order shall give the guardian ad litem complete access to [name of ward]’s protected health informa­tion. The guardian ad litem is further authorized to discuss with the physician or health-care provider any matters relating to [name of ward]’s health-care records and [name of ward]’s care, treatment, diagnosis, and needs.

SIGNED on ________________________________.

   
JUDGE PRESIDING