MPC 512 (8/30/19) REPC
ofpage
REPRESENTATIONS OF
RESPONDENT'S COUNSEL
Commonwealth of Massachusetts
The Trial Court
Probate and Family Court
Docket No.
In the Interests of:
Last Name
First Name
Middle Name
Incapacitated Person/Respondent
Division
1. I am the appointed counsel for the above named Respondent. I have represented my client in various mental health
related cases in this and other courts for months years.
2. A Motion to Extend and / or Amend the existing Order has been filed seeking authorization for treatment of the
months.
I do not object to entry of an order granting the moving party's motion.3.
Respondent with antipsychotic medications for an additional
I have reviewed the documents in this case which are relevant to the moving party's motion, including the Clinician's
4.
(date)
and the Report of the Court appointed Monitor.
Since the entry of the Order currently in effect, I have met with my client on the following occasions, at least one such
meeting being within thirty (30) days of the filing of this Representation, to discuss this motion:
5.
(date) (date) (date)
, , .
Affidavit and Report dated
This matter has been before the Court on the following dates:6.
(dates)
(initial determination of incompetency and substituted judgment)
and, most recently on
(date)
(review/extension/other).
In accordance with the decision in Guardianship of Brandon, 424 Mass. 482 (1997), to prevail at a hearing to contest the
moving party's motion, the Incapacitated Person would have the burden of demonstrating that there has been a substantial
change in circumstances since the entry of the Court's last order.
7.
(dates)
8.
9.
My client is aware of his/her right to participate in the instant proceeding, and does not wish to participate.
I agree with the moving party that the proposed Order, if issued, should be reviewed in
months.
Signature
(Print name)
Date:
B.B.O. #
Primary Phone #:
(Zip)(State)(City/Town)
(Address)
(Apt, Unit, No. etc.)
E-Mail:
