INSTRUCTIONS: CALIFORNIA ATTACHMENT REQUESTING SPECIAL ORDERS REGARDING DEMENTIA (Form GC-313)

The form discussed in this article is filed in California along with petitions for exclusive authority to give consent for medical treatment as the conservator of a person. This document can be obtained from the website maintained by the California Judicial Branch.

California Attachment Requesting Special Orders Regarding Dementia GC-313 Step 1: In the first blank box, enter the name of the conservatee.

California Attachment Requesting Special Orders Regarding Dementia GC-313 Step 2: In the second blank box, enter the case number.

California Attachment Requesting Special Orders Regarding Dementia GC-313 Step 3: Check the box on line 1a if you are requesting that you be authorized to place the conservatee in a secured perimeter residential care facility for the elderly which has a care plan meeting the requirements of the California Code of Regulations.

California Attachment Requesting Special Orders Regarding Dementia GC-313 Step 4: Check the box on line 1b if you are requesting to be authorized to administer medications appropriate for the care and treatment of dementia.

California Attachment Requesting Special Orders Regarding Dementia GC-313 Step 5: Check the box on line 3a if you have filed a medical declaration executed by a licensed physician or a licensed psychologist acting within the scope of his or her licensure with at least two years experience in diagnosing dementia.

California Attachment Requesting Special Orders Regarding Dementia GC-313 Step 6: Check the box on line 3b if you will file a medical declaration prior to the hearing which has been executed by a licensed physician or a licensed psychologist acting within the scope of his or her licensure with at least two years experience in diagnosing dementia.

California Attachment Requesting Special Orders Regarding Dementia GC-313 Step 7: Check the box on line 4 if you are requesting restricted placement, the conservatee lacks the capacity to give informed consent to this placement, and if the placement being proposed is the least restrictive placement appropriate to the needs of the conservatee.

California Attachment Requesting Special Orders Regarding Dementia GC-313 Step 8: Check the box on line 5 if you are requesting dementia medications which the conservatee needs or would benefit from and if the conservatee lacks the capacity to give informed consent to administration of these medications.