The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

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Here is the text we could read:

ATTORNEY OR PARTY WITHOUT ATTORNEY

STATE BAR NUMBER:

FOR COURT USE ONLY

GC-380

NAME:

FIRM NAME:

STREET ADDRESS:

CITY:

TELEPHONE NO.:

E-MAIL ADDRESS:

ATTORNEY FOR (name):

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

STATE:

FAX NO.:

ZIP CODE:

CONSERVATORSHIP OF THE OF (Name):

PERSON

ESTATE

PETITION FOR EXCLUSIVE AUTHORITY TO GIVE
CONSENT FOR MEDICAL TREATMENT

CONSERVATEE

CASE NUMBER:

1. Petitioner (name): requests that

the conservatee be adjudged to lack the capacity to give informed consent to medical treatment or healing by prayer.

the conservator of the person be granted the exclusive authority to give consent to medical treatment or healing by prayer that
the conservator in good faith based on medical advice determines to be necessary.

the treatment be performed by
his or her license

a licensed medical practitioner

a licensed psychologist within the scope of

an accredited practitioner of a religion that relies on prayer alone for healing.

orders related to the care and treatment of a major neurocognitive disorder (such as dementia) as specified in the
Attachment Requesting Special Orders Regarding a Major Neurocognitive Disorder be granted. (Attach form GC-313.)

the order dated (specify): made under Probate Code section 1880
be modified as specified in Attachment 1e

be revoked

be modified as follows (specify):

other orders be granted

as specified in Attachment 1f

as follows (specify):

g. Letters of Conservatorship be reissued to include a statement that conservator has the powers requested in this petition.

There is no form of medical treatment for which the proposed conservatee has the capacity to give informed consent.

Attached to this petition is a declaration executed by a licensed physician stating that the conservatee lacks the capacity to give
informed consent for any form of medical treatment and giving reasons and the factual basis for this conclusion. (Label as
Attachment 3.)

Conservatee an adherent of a religion that relies on prayer alone for healing as defined in Probate
Code section 2355(b).

is not

Form Adopted for Mandatory Use
Judicial Council of California
GC-380 [Rev. January 1, 2019]

PETITION FOR EXCLUSIVE AUTHORITY TO GIVE
CONSENT FOR MEDICAL TREATMENT
(Probate Conservatorship)

Page 1 of 2

Probate Code, § 1880 et seq.
www.courts.ca.gov

a.
b.

Date:

CONSERVATORSHIP OF (Name):

CASE NUMBER:

GC-380

CONSERVATEE

5. ATTENDANCE AT THE HEARING Conservatee

will attend the hearing.
is able but unwilling to attend the hearing AND wish to contest this petition.

does
is unable to attend the hearing because of medical inability. An affidavit or certificate of a licensed medical practitioner or
an accredited religious practitioner is affixed as Attachment 5c.
is not the petitioner, is out of state, and will not attend the hearing.

does not

Special notice been requested. (Specify the names and addresses of persons requesting
special notice in Attachment 6.)

has not

has

Filed with this petition is a proposed Order Appointing Court Investigator (form GC-330) that specifies the duties to be
performed before granting an order relating to medical consent .

The names, residence addresses, and relationships of the spouse and all relatives within the second degree of the conservatee so
far as known to petitioner are

listed in Attachment 8.

listed below

a. Spouse:

Relationship and name

Residence address

9. Number of pages attached:

Date:
*(Signature of all petitioners also required (Prob. Code, § 1020).)

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

(SIGNATURE OF ATTORNEY*)

(TYPE OR PRINT NAME )

(SIGNATURE OF PETITIONER)

(TYPE OR PRINT NAME )

(SIGNATURE OF PETITIONER)

GC-380 [Rev. January 1, 2019]

Page 2 of 2

PETITION FOR EXCLUSIVE AUTHORITY TO GIVE
CONSENT FOR MEDICAL TREATMENT
(Probate Conservatorship)

Petition for Exclusive Authority to Give Consent for Medical Treatment

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 2
Fields(s): 104
Average fields per page: 52
Reading Level: Grade 10
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

c_page_std_p_info_county was GC-380[0].Page1[0].StdP1Header[0].CourtInfo[0].CrtCounty[0] (0.55 conf)
g_c_page_std_p_header_court_info_crt_branch was GC-380[0].Page1[0].StdP1Header[0].CourtInfo[0].CrtBranch[0] (0.39 conf)
c_page_std_p_header_city was GC-380[0].Page1[0].StdP1Header[0].CourtInfo[0].CrtCityZip[0] (0.37 conf)
c_page_std_p_header_street was GC-380[0].Page1[0].StdP1Header[0].CourtInfo[0].CrtStreet[0] (0.39 conf)
page_header_court_info_crt_mailing was GC-380[0].Page1[0].StdP1Header[0].CourtInfo[0].CrtMailingAdd[0] (0.35 conf)
g_c_page_std_p_number was GC-380[0].Page1[0].StdP1Header[0].CaseNumber[0].CaseNumber[0] (0.37 conf)
c_page_std_p_header_info__1 was GC-380[0].Page1[0].StdP1Header[0].AttyInfo[0].State[0] (0.40 conf)
g_c_page_std_p_header_info__1 was GC-380[0].Page1[0].StdP1Header[0].AttyInfo[0].Zip[0] (0.40 conf)
c_page_std_p_header_info_city was GC-380[0].Page1[0].StdP1Header[0].AttyInfo[0].City[0] (0.40 conf)
c_page_std_p_header_info__2 was GC-380[0].Page1[0].StdP1Header[0].AttyInfo[0].Street[0] (0.40 conf)
g_c_page_std_p_header_info__2 was GC-380[0].Page1[0].StdP1Header[0].AttyInfo[0].Firm[0] (0.40 conf)
c_page_std_p_header_info_name was GC-380[0].Page1[0].StdP1Header[0].AttyInfo[0].Name[0] (0.40 conf)
c_page_std_p_header_info__3 was GC-380[0].Page1[0].StdP1Header[0].AttyInfo[0].Phone[0] (0.40 conf)
g_c_page_std_p_header_info__3 was GC-380[0].Page1[0].StdP1Header[0].AttyInfo[0].Fax[0] (0.40 conf)
c_page_std_p_header_email was GC-380[0].Page1[0].StdP1Header[0].AttyInfo[0].Email[0] (0.40 conf)
g_c_page_std_p_header_info__4 was GC-380[0].Page1[0].StdP1Header[0].AttyInfo[0].AttyFor[0] (0.39 conf)
g_c_page_std_p_header_info__5 was GC-380[0].Page1[0].StdP1Header[0].AttyInfo[0].BarNo[0] (0.37 conf)
g_c_page_std_p_header_cb__1 was GC-380[0].Page1[0].StdP1Header[0].CBChoice1_cb[0] (0.41 conf)
g_c_page_std_p_header_cb__2 was GC-380[0].Page1[0].StdP1Header[0].CBChoice1_cb[1] (0.41 conf)
g_c_page_std_p_header_party was GC-380[0].Page1[0].StdP1Header[0].Party1[0] (0.37 conf)
g_c_page_text_field__1 was GC-380[0].Page1[0].TextField6[0] (0.41 conf)
g_c_page_area_perf_cb__1 was GC-380[0].Page1[0].#area[0].perf_cb[0] (0.32 conf)
g_c_page_area_perf_cb__2 was GC-380[0].Page1[0].#area[1].perf_cb[1] (0.32 conf)
g_c_page_area_perf_cb__3 was GC-380[0].Page1[0].#area[2].perf_cb[2] (0.32 conf)
g_c_page_area_checkbox_cb__1 was GC-380[0].Page1[0].#area[3].checkbox_cb[0] (0.32 conf)
g_c_page_area_checkbox_cb__2 was GC-380[0].Page1[0].#area[4].checkbox_cb[1] (0.32 conf)
g_c_page_area_checkbox_cb__3 was GC-380[0].Page1[0].#area[5].checkbox_cb[2] (0.32 conf)
g_c_page_area_checkbox_cb__4 was GC-380[0].Page1[0].#area[6].checkbox_cb[3] (0.32 conf)
g_c_page_area_checkbox_cb__5 was GC-380[0].Page1[0].#area[7].checkbox_cb[4] (0.32 conf)
g_c_page_area_date_field was GC-380[0].Page1[0].#area[7].DateField1[0] (0.41 conf)
g_c_page_text_field__2 was GC-380[0].Page1[0].TextField6[1] (0.41 conf)
g_c_page_area_checkbox_cb__6 was GC-380[0].Page1[0].#area[8].checkbox_cb[5] (0.32 conf)
g_c_page_area_checkbox_cb__7 was GC-380[0].Page1[0].#area[9].checkbox_cb[6] (0.32 conf)
g_c_page_area_checkbox_cb__8 was GC-380[0].Page1[0].#area[10].checkbox_cb[7] (0.32 conf)
g_c_page_text_field__3 was GC-380[0].Page1[0].TextField6[2] (0.41 conf)
g_c_page_area_cb__1 was GC-380[0].Page1[0].#area[11].is_cb[0] (0.32 conf)
g_c_page_area_cb__2 was GC-380[0].Page1[0].#area[12].is_cb[1] (0.32 conf)
g_c_page_caption_case_number was GC-380[0].Page2[0].PxCaption_sf[0].CaseNumber[0].CaseNumber[0] (0.36 conf)
c_page_caption_title_party_name was GC-380[0].Page2[0].PxCaption_sf[0].TitlePartyName[0].Party1[0] (0.37 conf)
g_c_page_sig_date__1 was GC-380[0].Page2[0].SigDate[0] (0.33 conf)
g_c_page__1 was GC-380[0].Page2[0].T14[0] (0.33 conf)
g_c_page_area_checkbox__1 was GC-380[0].Page2[0].#area[0].checkbox[0] (0.32 conf)
g_c_page_area_checkbox__2 was GC-380[0].Page2[0].#area[1].checkbox[1] (0.32 conf)
g_c_page_area_checkbox__3 was GC-380[0].Page2[0].#area[2].checkbox[2] (0.32 conf)
g_c_page_area_checkbox__4 was GC-380[0].Page2[0].#area[3].checkbox[3] (0.32 conf)
g_c_page_area_checkbox__5 was GC-380[0].Page2[0].#area[4].checkbox[4] (0.32 conf)
g_c_page_area_checkbox__6 was GC-380[0].Page2[0].#area[5].checkbox[5] (0.32 conf)
g_c_page_area__1 was GC-380[0].Page2[0].#area[6].has[0] (0.32 conf)
g_c_page_area__2 was GC-380[0].Page2[0].#area[7].has[1] (0.32 conf)
g_c_page_area_checkbox__7 was GC-380[0].Page2[0].#area[8].checkbox[6] (0.32 conf)
g_c_page_area_checkbox__8 was GC-380[0].Page2[0].#area[9].checkbox[7] (0.32 conf)
g_c_page_area_checkbox__9 was GC-380[0].Page2[0].#area[10].checkbox[8] (0.32 conf)
g_c_page_fill_text was GC-380[0].Page2[0].FillText[0] (0.38 conf)
g_c_page_text_field__4 was GC-380[0].Page2[0].TextField6[0] (0.41 conf)
g_c_page_text_field__5 was GC-380[0].Page2[0].TextField6[1] (0.41 conf)
g_c_page_text_field__6 was GC-380[0].Page2[0].TextField6[2] (0.41 conf)
g_c_page_text_field__7 was GC-380[0].Page2[0].TextField6[3] (0.41 conf)
g_c_page_text_field__8 was GC-380[0].Page2[0].TextField6[4] (0.41 conf)
g_c_page_text_field__9 was GC-380[0].Page2[0].TextField6[5] (0.41 conf)
g_c_page_text_field__10 was GC-380[0].Page2[0].TextField6[6] (0.41 conf)
g_c_page_text_field__11 was GC-380[0].Page2[0].TextField6[7] (0.41 conf)
g_c_page_text_field__12 was GC-380[0].Page2[0].TextField6[8] (0.41 conf)
g_c_page_text_field__13 was GC-380[0].Page2[0].TextField6[9] (0.41 conf)
g_c_page_text_field__14 was GC-380[0].Page2[0].TextField6[10] (0.41 conf)
g_c_page_text_field__15 was GC-380[0].Page2[0].TextField6[11] (0.41 conf)
g_c_page_text_field__16 was GC-380[0].Page2[0].TextField6[12] (0.41 conf)
g_c_page_text_field__17 was GC-380[0].Page2[0].TextField6[13] (0.41 conf)
g_c_page_text_field__18 was GC-380[0].Page2[0].TextField6[14] (0.41 conf)
g_c_page_text_field__19 was GC-380[0].Page2[0].TextField6[15] (0.41 conf)
g_c_page_text_field__20 was GC-380[0].Page2[0].TextField6[16] (0.41 conf)
g_c_page_text_field__21 was GC-380[0].Page2[0].TextField6[17] (0.41 conf)
g_c_page_text_field__22 was GC-380[0].Page2[0].TextField6[18] (0.41 conf)
g_c_page_text_field__23 was GC-380[0].Page2[0].TextField6[19] (0.41 conf)
g_c_page_text_field__24 was GC-380[0].Page2[0].TextField6[20] (0.41 conf)
g_c_page_text_field__25 was GC-380[0].Page2[0].TextField6[21] (0.41 conf)
g_c_page_text_field__26 was GC-380[0].Page2[0].TextField6[22] (0.41 conf)
g_c_page_text_field__27 was GC-380[0].Page2[0].TextField6[23] (0.41 conf)
g_c_page_text_field__28 was GC-380[0].Page2[0].TextField6[24] (0.41 conf)
g_c_page_text_field__29 was GC-380[0].Page2[0].TextField6[25] (0.41 conf)
g_c_page_text_field__30 was GC-380[0].Page2[0].TextField6[26] (0.41 conf)
g_c_page_text_field__31 was GC-380[0].Page2[0].TextField6[27] (0.41 conf)
g_c_page_text_field__32 was GC-380[0].Page2[0].TextField6[28] (0.41 conf)
g_c_page_text_field__33 was GC-380[0].Page2[0].TextField6[29] (0.41 conf)
g_c_page_text_field__34 was GC-380[0].Page2[0].TextField6[30] (0.41 conf)
g_c_page_text_field__35 was GC-380[0].Page2[0].TextField6[31] (0.41 conf)
g_c_page_text_field__36 was GC-380[0].Page2[0].TextField6[32] (0.41 conf)
g_c_page_text_field__37 was GC-380[0].Page2[0].TextField6[33] (0.41 conf)
g_c_page_text_field__38 was GC-380[0].Page2[0].TextField6[34] (0.41 conf)
g_c_page_text_field__39 was GC-380[0].Page2[0].TextField6[35] (0.41 conf)
g_c_page_text_field__40 was GC-380[0].Page2[0].TextField6[36] (0.41 conf)
g_c_page_text_field__41 was GC-380[0].Page2[0].TextField6[37] (0.41 conf)
g_c_page_text_field__42 was GC-380[0].Page2[0].TextField6[38] (0.41 conf)
g_c_page_text_field__43 was GC-380[0].Page2[0].TextField6[39] (0.41 conf)
g_c_page_text_field__44 was GC-380[0].Page2[0].TextField6[40] (0.41 conf)
g_c_page_text_field__45 was GC-380[0].Page2[0].TextField6[41] (0.41 conf)
g_c_page_text_field__46 was GC-380[0].Page2[0].TextField6[42] (0.41 conf)
g_c_page_text_field__47 was GC-380[0].Page2[0].TextField6[43] (0.41 conf)
g_c_page_text_field__48 was GC-380[0].Page2[0].TextField6[44] (0.41 conf)
g_c_page_text_field__49 was GC-380[0].Page2[0].TextField6[45] (0.41 conf)
g_c_page_text_field__50 was GC-380[0].Page2[0].TextField6[46] (0.41 conf)
g_c_page_pages_att was GC-380[0].Page2[0].PagesAtt[0] (0.34 conf)
g_c_page_sig_date__2 was GC-380[0].Page2[0].SigDate[1] (0.33 conf)
g_c_page_sig_date__3 was GC-380[0].Page2[0].SigDate[2] (0.33 conf)
g_c_page__2 was GC-380[0].Page2[0].T14[1] (0.33 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

c_page_std_p_info_county
g_c_page_std_p_header_court_info_crt_branch
c_page_std_p_header_city
c_page_std_p_header_street
page_header_court_info_crt_mailing
g_c_page_std_p_number
c_page_std_p_header_info__1
g_c_page_std_p_header_info__1
c_page_std_p_header_info_city
c_page_std_p_header_info__2
g_c_page_std_p_header_info__2
c_page_std_p_header_info_name
c_page_std_p_header_info__3
g_c_page_std_p_header_info__3
c_page_std_p_header_email
g_c_page_std_p_header_info__4
g_c_page_std_p_header_info__5
g_c_page_std_p_header_cb__1
g_c_page_std_p_header_cb__2
g_c_page_std_p_header_party
g_c_page_text_field__1
g_c_page_area_perf_cb__1
g_c_page_area_perf_cb__2
g_c_page_area_perf_cb__3
g_c_page_area_checkbox_cb__1
g_c_page_area_checkbox_cb__2
g_c_page_area_checkbox_cb__3
g_c_page_area_checkbox_cb__4
g_c_page_area_checkbox_cb__5
g_c_page_area_date_field
g_c_page_text_field__2
g_c_page_area_checkbox_cb__6
g_c_page_area_checkbox_cb__7
g_c_page_area_checkbox_cb__8
g_c_page_text_field__3
g_c_page_area_cb__1
g_c_page_area_cb__2
g_c_page_caption_case_number
c_page_caption_title_party_name
g_c_page_sig_date__1
g_c_page__1
g_c_page_area_checkbox__1
g_c_page_area_checkbox__2
g_c_page_area_checkbox__3
g_c_page_area_checkbox__4
g_c_page_area_checkbox__5
g_c_page_area_checkbox__6
g_c_page_area__1
g_c_page_area__2
g_c_page_area_checkbox__7
g_c_page_area_checkbox__8
g_c_page_area_checkbox__9
g_c_page_fill_text
g_c_page_text_field__4
g_c_page_text_field__5
g_c_page_text_field__6
g_c_page_text_field__7
g_c_page_text_field__8
g_c_page_text_field__9
g_c_page_text_field__10
g_c_page_text_field__11
g_c_page_text_field__12
g_c_page_text_field__13
g_c_page_text_field__14
g_c_page_text_field__15
g_c_page_text_field__16
g_c_page_text_field__17
g_c_page_text_field__18
g_c_page_text_field__19
g_c_page_text_field__20
g_c_page_text_field__21
g_c_page_text_field__22
g_c_page_text_field__23
g_c_page_text_field__24
g_c_page_text_field__25
g_c_page_text_field__26
g_c_page_text_field__27
g_c_page_text_field__28
g_c_page_text_field__29
g_c_page_text_field__30
g_c_page_text_field__31
g_c_page_text_field__32
g_c_page_text_field__33
g_c_page_text_field__34
g_c_page_text_field__35
g_c_page_text_field__36
g_c_page_text_field__37
g_c_page_text_field__38
g_c_page_text_field__39
g_c_page_text_field__40
g_c_page_text_field__41
g_c_page_text_field__42
g_c_page_text_field__43
g_c_page_text_field__44
g_c_page_text_field__45
g_c_page_text_field__46
g_c_page_text_field__47
g_c_page_text_field__48
g_c_page_text_field__49
g_c_page_text_field__50
g_c_page_pages_att
g_c_page_sig_date__2
g_c_page_sig_date__3
g_c_page__2

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Petition for Exclusive Authority to Give Consent for Medical Treatment

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02