WPC  
      :     3岕+vPc{((m g9y: WfX8t(KDӌw&*hd\p@Ӧz3ƐzDgWaU|7|]gQWaIb-	^9r
)/GX={嵭9.snTyuO@,N:_'qNi.yNehӅ樮q"kC+1gش=Y+E*F$3ELcغYECL$N6FR^~Λ9!b,7dCW~iTSΖgk#$n`S}{02mEͤ@	-6~d~e~ЈP@_SU/Vp7	t'R_ApKo5?"B"Ty1NϚ.8zQ~ᩍ~u[jB
"̋Oz'_ (           #     0   U   N     	%      G  0   :   M   U   *      U   >     0   d    0   2  S	  0   U   
   U
   >   
  0   U           m  N      \   	      ^   	      n   	      ~   	         	         	         	         	        ^        w        4                        	m         b      .     s   6            6  	1   {     0      $  0   Y    0      -  0        	7   2     	1   u     	7   2   S  0   c      H P L J 3 3 0 0                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              0                                                                                                                                                                 ( 9  	   Z  6 T i m e s   N e w   R o m a n   R e g u l a r           X    (                  $          USUS. ,  % 2  A   `   A r i a l          \	  	   `  & T i m e s   N e w   R o m a n             0                . H e a d e r           (#     X      XX S 
           \	  	   `   & T i m e s   N e w   R o m a n         S  A  7        X   `	   h   p    x   (#A S 
           \	  	   `   & T i m e s   N e w   R o m a n         S     X      XX     0   m             . F o o t e r           (# S 
           \	  	   `   & T i m e s   N e w   R o m a n         S  A  7        X   `	   h   p    x   (#A S 
           \	  	   `   & T i m e s   N e w   R o m a n         S     (   -               2$       
   !    USUS. ,       \	  	   `   & T i m e s   N e w   R o m a n             (   -               2$       
   !    USUS. ,       
      
 	  '    USUS. ,      _            $      (#   X$    X  X  X X    
  X  X  X X              =           T e x t 1    T e x t 2    T e x t 3    T e x t 4    T e x t 5    T e x t 6    C h e c k 1    C h e c k 2   76Z         DM6    :i +003| x                    U  -  -    
   i   _             @ @  *  _        8/1/07_           	 X                       8j        3 C I O U [ a g m    N u m b e r s   1 .   1 .   1 .   1 .   1 .   1 .   1 .   1 .               H   4          '   4 H e a d i n g   2   H e a d i n g   2                  
                              H                4 H e a d i n g   3   H e a d i n g   3         
   33 2             ?           % 2  A   `   A r i a l         ? 
                     S            \	  	   `  & T i m e s   N e w   R o m a n         S 
   33 2      H   :          *   4 H e a d i n g   4   H e a d i n g   4                  
                              H   ?          2   4 H e a d i n g   5   H e a d i n g   5       X      XX            
                                       1 .                                                        3#   3 7 = C I Q Y a g       1 .   a .   i .   ( 1 )   ( a )   ( i )   1 )   a )            %    i )                                           (       ;           3$       2  #      0
   
 .3
   
 0     
   !    USUS. ,      _               @    VV)  112   	 0               X    ,                       8    X  X       d                  d  8 =      X   X       d                 d= _                 _         
  X  X  X X   INTHEDISTRICTCOURTOF     %     -     ________________-     %       ԀCOUNTY,KANSAS   	          3   	    p    x   (#   X3    33     INTHEINTERESTOF:   	    Ѐ   	       _  .  0      p" (#    pX0 Name%     -     __________________________________-     %           p CaseNo.%     -     _____________________-     %          	 
      .  _   <   	    z    x   (#   p" (#<       33  DOB%     -     xx/xx/____%    U   %     %       %     -     %       Ԁ0     A#   X  X  X
 X  #    X  X  X X &#   X  X  X X  #  
  X  X  X X %     %    s   Ԁmale%     #   X  X  X
 XT  #  
  X  X  X X Ԁ#   X  X  X
 X  #    X  X  X X &#   X  X  X X
  # %        
  X  X  X X Ԁfemale    1 (#(#     _  .   <        z p" (#    z X<    33     _        #   X  X  X
 Xa  #  "        @   X X      
           "  <           X  X  @ ORDERAPPOINTINGGUARDIANADLITEM "  <         
}   Ԍ   	 	
   Ќ        X  X  X X 	     @      PursuanttoK.S.A.   X  X  X X 382205#   X  X  X X  # #   @   X X  #    X  X  @ Ԉ   	 
   #   @   X X		  #       @            33       #   @   a	  #    X  X  @ NOW,onthis______dayof_______________,_______,______________________is   	    appointedguardianadlitemforthechildnamedabove.Theguardianadlitemscontactinformation   	    isshownbelow.Theguardianadlitemshallmakeanindependentinvestigationofthefactsupon   	    whichthePetitionisbasedandshallappearforandrepresentthebestinterestsofthechild   	 n   throughouttheproceedings.   	 vF    
                   ( j        9                                3                            %                    " '  3                   "      '  3v   2  j      1
   
 .3
   
 0          Theguardianadlitemshallbeservedwithcopiesofallpleadingsanddocumentsfiled   	 N   herein. '  3v     ݌    & (#(#  Ќ	     " '  3                  "      '  3   2  j      2
   
 .3
   
 0          TheguardianadlitemshallcomplywithSupremeCourtAdministrativeOrderno.100. '  3     ݌     (#(#  Ќ	     " '  3                  "      '  3   2  j      3
   
 .3
   
 0          Thefollowingareherebyorderedtopermittheguardianadlitemtoinspectandcopyany   	    recordsintheirpossessionrelatingtothechildnamedaboveand/orthechildsparents,   	 !~   ___(Nameparents)___:schoolandschooldistrict;ClerkoftheCourt;lawenforcement   	 #V!   agency;healthcareproviderorfacility;mentalhealthcareproviderorfacility;substance   	 ^%.!#   abusetreatmentproviderorfacility;socialworker;anyagency,organization,personor   	 6'#%   officeinpossessionofrecordsrelatingtothechildorparents. '  3     ݌    )$' (#(#  Ќ	     " '  3                  "      '  3(   2  j      4
   
 .3
   
 0          Theguardianadlitemisauthorizedtomeetwith,interviewandobtaininformationfrom   	 *&)   schoolteachers,staffandadministrators,andallothersnamedabove.Theguardianadlitem   	 ,(+   shallmaintaininformationreceivedfromanysourcenamedaboveasconfidentialand_        shall   	 .f*-   notdisclosethatinformationexceptinreportstotheCourt,tothepartiestothiscaseand   	 0      counsel,asdirectedbytheCourt,andasnecessarytocarryoutthepurposesofthecode. '  3(  U   ݌     (#(#  Ќ	     " '  3                  "      '  3*   2  j      5
   
 .3
   
 0          Theguardianadlitemisherebyvestedwithallpowers,privilegesandresponsibilities   	    necessaryforthefullandeffectiveperformanceofthedutiesandobligationstothechildas   	 	   setforthinthisorder. '  3*  W   ݌    ` (#(#  Ќ	     " '  3                  "      '  3   2  j      6
   
 .3
   
 0           
  X  X  X X Allprovidersofservices,treatmentorcare_        for_        Ԁthechildandfamily,evenifnotspecifically   	 h8	
   referredtoherein,shallprovideinformationtotheguardianadlitemasrequested.Thisorder   	 @   encompassesandisincompliancewiththeprovisionsofthePrivacyRuleoftheHealth   	    InsurancePortabilityandAccountabilityActof1996(HIPAA),45C.F.R.164.512(e)(1). '  3     ݌     (#(#  Ќ	     #   X  X  X
 Xw  # " '  3                  "      '  3   2  j      7
   
 .3
   
 0          Thecaptionedmatterissetfor______________________hearingonthe______dayof   	    __________________,_______,at________a.m.p.m. '  3     ݌    p (#(#  Ќ	          ITISSOORDERED.   	 xH                                z 0    p _________________________    P  p(#p(#     X      X   N  ( 	 	 	 0   8   @   H!     z p" (#N      0         h               p JudgeoftheDistrictCourt    < (#(#       X    	 (        X         Attorneyname:_____________________________   	    Address:    `	 ______________________________   	 :!
!        0    `	 ______________________________    "l# `	(#`	(#  Phone:0    `	 ________________    #% `	(#`	(#  FAX:0     0    `	(#(# ________________    `%0!' `	(#`	(#            @    jj&  Authority   	 (j$+   K.S.A.382205.   	 r*B&-   @    *         	 /*2   NotesonUse   	 0      _                  UponthefilingofaChildinNeedofCarepetition,thecourtisrequiredtoappointan   	    attorneytoserveasguardianadlitemforthechildwhoisthesubjectofthepetition.Theattorney   	    shallmakeanindependentinvestigationofthecaseandappearforandrepresentthebestinterests   	    ofthechild.Thisformservesasacourtorderforreleaseofinformation,whichisrequiredbymost   	    agencies.Theformmaybechangedasneeded,andspecificagenciesorprovidersmaybeinserted.   	 	        Theguardianadlitemshallinformthecourtwhenthechildspositionisnotconsistentwith   	 
t   theguardianadlitemsdeterminationofthechildsbestinterest.Theguardianadlitemorthechild   	 `   mayrequestthatasecondattorneybeappointed,toserveasattorneyforthechild.Theattorneyfor   	 |L	   thechildmayrequirethatcommunicationbetweenthechildandtheguardianadlitemoccurinthe   	 h8	
   attorneyspresence.Theguardianadlitemshallcontinuetorepresentthechildsbestinterest   	 T$
   throughouttheproceedings,includinganyappellateproceedings,unlessrelievedbythecourtupon   	 @   ashowingofgoodcause,orupontransferofvenue.Thefeesfortheguardianadlitemmaybe   	 ,   assessedasanexpenseintheproceedingstobepaidbythecomplainingwitness,apersoninitiating   	    theproceedings,apartyoraninterestedparty,otherthanthestate,asdeterminedbythecourt.Upon   	    transferofvenue,thetransferringcourtshallsendtothereceivingcourtastatementofexpensespaid   	    fromthegeneralfundofthetransferringcounty.   	    @    *  
