CONSERVATORSHIP OF (Name):

CASE NUMBER:

 CONSERVATEE

GC-313

ATTACHMENT REQUESTING SPECIAL ORDERS  
REGARDING A MAJOR NEUROCOGNITIVE DISORDER 

Petition for Appointment of Probate Conservator (form GC-310)
Petition for Exclusive Authority to Give Consent for Medical Treatment (form GC-380)

a.

b.

a.
b.

2.

3.

4.

5.

1.

Petitioner requests that the conservator of the person be authorized 

to place the conservatee in a secured-perimeter residential care facility for the elderly operated under Health and Safety  
Code section 1569.698 that has a care plan that meets the requirements of California Code of Regulations, title 22,  
section 87705.
to authorize the administration of medications appropriate for the care and treatment of major neurocognitive disorders 
(including dementia).

The conservatee or proposed conservatee has a major neurocognitive disorder (such as dementia) as defined in the current edition 
of the Diagnostic and Statistical Manual of Mental Disorders.

A medical declaration executed by a licensed physician or a licensed psychologist acting within the scope of his or her license with 
at least two years' experience in diagnosing and treating major neurocognitive disorders (including dementia):

has been filed.
will be filed before the hearing.

Restricted placement. The conservatee needs or would benefit from placement as requested in item 1a. The conservatee  
lacks capacity to give informed consent to this placement. The placement requested is the least restrictive placement  
appropriate to the needs of the conservatee.

Medications. The conservatee needs or would benefit from administration of medications appropriate to the care and 
treatment of major neurocognitive disorders (including dementia). The conservatee lacks capacity to give informed 
consent to the administration of those medications.

Form Adopted for Mandatory Use  
Judicial Council of California 
GC-313 [Rev. January 1, 2019]

ATTACHMENT REQUESTING SPECIAL ORDERS  
REGARDING A MAJOR NEUROCOGNITIVE DISORDER

Page 1 of 1

Probate Code, § 2356.5 
www.courts.ca.gov