GUARDIAN’S QUARTERLY REPORT
Deadlines:
Jan-March (Due by April 15)
April-June (Due by July 15)
July-Sept (Due by Oct 15)
Oct-Dec (Due by Jan 15)
Ward:
# of Hours this quarter (round to the nearest 1/2 hour). Include visits, phone calls, meetings, written communication, shopping
# of visits this quarter
1. How Is Your Ward? (note medical conditions, appearance, behaviors, changes; can also include observations about facility and staff)
2. Describe Your Visits/Activities With or on Behalf of Ward.
3. Plans/Goals for Next Quarter
4. What Assistance Do You Need?
Guardian Address/Phone Number/E-Mail Changes
Guardian Signature
Date
-
Month
-
Day
Year
Date
Guardianship Assistance Program
MOW Social Services
PO Box 12411
Norwood, OH 45212
Submit
Should be Empty: