PM 16-04-03.

(FCRC)

Complete current Form 552 when a guardian is appointed or changed, except for a limited guardian or temporary guardian:

  • Item 2 - Enter the effective date (MMYY).
  • Item 3 - Enter 31.
  • Item 8 - Line out the client's name and enter the guardian's name followed by GRDN. Show the guardian's name as shown on the guardianship papers. If the Office of the State Guardian of the Guardianship and Advocacy Commission is the legally appointed guardian, enter Office of State Guardian.
    • NOTE: If both a guardian of the estate and a guardian of the person have been appointed, use the guardian of the person.
  • Items 9 & 10 - Line out the client's address and enter the client's last name and their initials followed by the guardian's address. Show the guardian's address as shown on the guardianship papers. If the guardian requests the medical card be mailed to the client, enter the client's address.
  • Item 33 - Enter the appropriate Reason Code.
    • NOTE: In REMARKS enter Guardian Appointed or Guardian Changed, as required.
  • Item 44 - Complete.
  • Item 45 - An entry is required for MANG clients in long term care facilities. If the guardian wants the medical card mailed to their address instead of the facility where the client lives, enter E in the first position of Item 45, followed by 4 numbers. The number is the month and year Form 552 is coded (see WAG 22-01-04).
  • Item 46 - Line out any entry in this item.
  • Items 50-52 - Complete when applicable.

Submit a change of address on a guardian only if the guardian's address is used and it changes. If the client's address is used and it changes, submit a change of address.

When a guardian is withdrawn, complete the current Form 552:

  • Item 3 - Enter 31.
  • Items 8-10 - Line out the guardian's name and address. Enter the client's name and address.
  • REMARKS - Enter Guardian Withdrawn.

If a guardian is appointed when a case is approved, enter the required guardian information on the approval Form 552.