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Here is the text we could read:

 

ity, State, Zip 

 
Name 

ddress 

hone 

mail 

  A

  C

  P

  E

In the District Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

In the Matter of Protection for 

Order Appointing Physician to 
Examine the Respondent in a 
Conservatorship Proceeding 

___________________________________, 
Respondent 

_______________________________ 
Case Number 

_______________________________ 
Judge 

Under Section 75-5-407, the court may appoint a physician to examine the 
respondent. 

The court needs more evidence of the nature and extent of the respondent’s 
alleged mental illness, mental deficiency, physical illness or disability, chronic 
use of drugs, or chronic intoxication. 

3. 

________________________________________________________ (name) is a  

physician licensed in the state of ____________________. 

Therefore the court orders that: 

The person named in Paragraph 3 is appointed to examine the respondent and 
submit a written report to the court. 

1. 

2. 

4. 

 

Order Appointing Physician to Examine the 
Respondent in a Conservatorship Proceeding 
 

Approved Board of District Court Judges December 14, 2012 
Revised January 27, 2020 

Page 1 of 3 

udge’s signature may instead appear at the top of the first page of this document. 

Signature ► 

 

 

Judge 

  J

 
Date 

Order Appointing Physician to Examine the 
Respondent in a Conservatorship Proceeding 
 

Approved Board of District Court Judges December 14, 2012 
Revised January 27, 2020 

Page 2 of 3 

 

 

 

 

 
Date 

 

Certificate of Service 

I certify that I filed with the court and am serving a copy of this Order Appointing Physician to Examine the 
Respondent in a Conservatorship Proceeding on the following people. 

Person’s Name 

Service Method 

Service Address 

Service 
Date 

 

 

 

 

 

 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email 
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email 
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

[  ]  Mail 
[  ]  Hand Delivery 
[  ]  E-filed 
[  ]  Email  
[  ]  Left at business (With person in charge 

or in receptacle for deliveries.) 

[  ]  Left at home (With person of suitable 

age and discretion residing there.) 

Signature ► 

Printed Name 

 

 

Order Appointing Physician to Examine the 
Respondent in a Conservatorship Proceeding 
 

Approved Board of District Court Judges December 14, 2012 
Revised January 27, 2020 

Page 3 of 3

Order Appointing Physician to Examine the Respondent in a Conservatorship Proceeding

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Utah 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 legacy.utcourts.gov (2023-03)
Page(s): 3
Fields(s): 75
Average fields per page: 25
Reading Level: Grade 11
LIST Grouping(s): GO-00-00-00-00.

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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.

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

Order Appointing Physician to Examine the Respondent in a Conservatorship Proceeding

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Identified Data Fields:

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