FORM MH-109 GC letters & acceptance

• Legal Form Number: FORM MH-109
• Date: 01 January 2014
• Section: Az Mh Forms Annotated

FORM MH-109

[Attorney’s name, State Bar No.]

[Attorney’s law firm name]

[Law firm bar number]

[Address]

[Phone number]

[Attorney or firm’s e-mail address]

Attorney for: __________

SUPERIOR COURT OF ARIZONA, __________ COUNTY

In the Matter of the Guardianship of and Conservatorship for: an Adult. NO. __________ LETTERS OF Guardian and CONSERVATOR AND ACCEPTANCE OF APPOINTMENT WITH MENTAL HEALTH POWERS

LETTERS OF GUARDIAN AND CONSERVATOR

1. [Appointee’s name] is appointed guardian of [ward’s name] and granted the general powers of a guardian pursuant to A.R.S. §§ 14-5312, -5312.01 and -5312.01(B), including but not limited to the power to consent for [ward’s name] to receive inpatient mental health care and treatment and be placed in a level one behavioral health facility licensed by the Arizona Department of Health Services for medical, psychiatric, and psychological treatment, subject to the following restrictions: .

2. [Appointee’s name] is appointed conservator for [protected person’s name] and is granted the general powers of a conservator pursuant to A.R.S. §§ 14-5424 and -5425.

3. Unless modified by subsequent court order, Guardian’s authority to consent to inpatient mental health care and treatment shall expire on __________ (not more than one year from the date of order). The expiration of these mental health powers shall not terminate [guardian’s name]’s appointment as guardian or conservator and shall not affect Guardian’s general powers under A.R.S. §§ 14-5312 and 5312.01(A), including his or her power to consent for Ward to receive psychiatric and psychological care, including the administration of psychotropic medications, that takes place outside a level one behavioral health facility licensed by the Arizona...