RCW 11.130.745
Form.
(1) Subject to subsection (2) of this section, a supported decision-making agreement is valid only if it is in substantially the following form:
SUPPORTED DECISION-MAKING AGREEMENT
Appointment of Supporter
I, ..... (name of supported adult), make this agreement of my own free will.
I agree and designate that:
Name: ..... (name of supporter)
Address: ..... (address of supporter)
Phone Number: ..... (phone number of supporter)
Email Address: ..... (email address of supporter)
is my supporter.
My supporter may help me with making everyday life decisions relating to the following:
(Y/N) Obtaining food, clothing, and shelter.
(Y/N) Taking care of my health.
(Y/N) Managing my financial affairs.
(Y/N) Other matters: ..... (specify).
My supporter is not allowed to make decisions for me. To help me with my decisions, my supporter may:
1. Help me access, collect, or obtain information that is relevant to a decision, including medical, psychological, financial, educational, or treatment records;
2. Help me understand my options so I can make an informed decision; and
3. Help me communicate my decision to appropriate persons.
(Y/N) A release allowing my supporter to see protected health information under the Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, is attached.
(Y/N) A release allowing my supporter to see educational records under the Family Educational Rights and Privacy Act of 1974, 20 U.S.C. Sec. 1232g, is attached.
Effective Date of Supported Decision-Making Agreement
This supported decision-making agreement is effective immediately and will continue until ..... (insert date) or until the agreement is terminated by my supporter or me or by operation of law.
Signed this ..... (day) day of ..... (month), ..... (year)
Consent of Supporter
I, ..... (name of supporter), acknowledge my responsibilities and consent to act as a supporter under this agreement.
(Signature of supporter)
(Printed name of supporter)
Supporter
(Signature of supported adult)
(Printed name of supported adult)
Supported Adult
(Signature of witness 1)
(Printed name of witness 1)
Witness 1
(Signature of witness 2)
(Printed name of witness 2)
Witness 2
State of .....
County of .....
This record was acknowledged before me on ..... (date) by ..... (name(s) of individuals).
. . . .
(Signature of notary public)
(Stamp)
. . . .
(Title of office)
My commission expires:
. . . .
(Date)
WARNING: PROTECTION FOR VULNERABLE ADULTS AS DEFINED UNDER CHAPTER 74.34 RCW.
IF A PERSON WHO RECEIVES A COPY OF THIS AGREEMENT OR IS AWARE OF THE EXISTENCE OF THIS AGREEMENT HAS CAUSE TO BELIEVE THAT A VULNERABLE ADULT IS BEING ABUSED, ABANDONED, NEGLECTED (INCLUDING SELF-NEGLECT), OR PERSONALLY OR FINANCIALLY EXPLOITED BY THE SUPPORTER, THE PERSON SHALL REPORT THE ALLEGED ABUSE, ABANDONMENT, NEGLECT, SELF-NEGLECT, OR PERSONAL OR FINANCIAL EXPLOITATION TO THE DEPARTMENT OF SOCIAL AND HEALTH SERVICES BY CALLING THE ABUSE HOTLINE AT 1-800-END-HARM.
(2) A supported decision-making agreement may be in any form not inconsistent with subsection (1) of this section and the other requirements of this chapter.
[ 2020 c 312 § 610.]
NOTES:
Effective dates—2020 c 312: See note following RCW 11.130.915.
Structure Revised Code of Washington
Title 11 - Probate and Trust Law
Chapter 11.130 - Uniform Guardianship, Conservatorship, and Other Protective Arrangements Act.
11.130.015 - Supplemental principles of law and equity applicable.
11.130.020 - Subject matter jurisdiction.
11.130.025 - Transfer of proceeding.
11.130.035 - Practice in court.
11.130.037 - Presumption of legal capacity.
11.130.040 - Letters of office.
11.130.045 - Effect of acceptance of appointment.
11.130.050 - Co-guardian—Co-conservator.
11.130.055 - Judicial appointment of successor guardian or successor conservator.
11.130.060 - Effect of death, removal, or resignation of guardian or conservator.
11.130.065 - Notice of hearing generally.
11.130.070 - Waiver of notice.
11.130.075 - Guardian ad litem.
11.130.080 - Request for notice.
11.130.085 - Disclosure of bankruptcy or criminal history.
11.130.095 - Multiple nominations.
11.130.100 - Compensation and expenses—In general.
11.130.105 - Compensation of guardian or conservator.
11.130.115 - Petition after appointment for instruction or ratification.
11.130.120 - Third-party acceptance of authority of guardian or conservator.
11.130.125 - Use of agent by guardian or conservator.
11.130.130 - Temporary substitute guardian or conservator.
11.130.135 - Registration of order—Effect.
11.130.140 - Grievance or complaint against guardian or conservator.
11.130.145 - Delegation by parent.
11.130.150 - Ex parte communications—Removal.
11.130.155 - Registry for guardians ad litem and visitors.
11.130.160 - Guardianship/conservatorship summary.
11.130.165 - Guardianship/conservatorship courthouse facilitator program.
11.130.175 - Guardianships involving veterans.
11.130.180 - Construction—Chapter applicable to state registered domestic partnerships—2009 c 521.
11.130.185 - Basis for appointment of guardian for minor.
11.130.190 - Petition for appointment of guardian for minor.
11.130.195 - Notice of hearing for appointment of guardian for minor.
11.130.200 - Attorney for minor or parent.
11.130.205 - Attendance and participation at hearing for appointment of guardian for minor.
11.130.210 - Custody orders—Background information to be consulted.
11.130.215 - Order of appointment—Priority of nominee—Limited guardianship for minor.
11.130.220 - Standby guardian for minor.
11.130.225 - Emergency guardian for minor.
11.130.230 - Duties of guardian for minor.
11.130.235 - Powers of guardian for minor.
11.130.240 - Removal of guardian for minor—Termination of guardianship—Appointment of successor.
11.130.245 - Prior court order validity.
11.130.250 - Application of the Indian child welfare act.
11.130.257 - Temporary support, restraining, and protective orders—Effect—Support debts to state.
11.130.259 - Order for relocation.
11.130.260 - Health insurance coverage—Conditions.
11.130.265 - Basis for appointment of guardian for adult.
11.130.270 - Petition for appointment of guardian for adult.
11.130.275 - Notice of hearing for appointment of guardian for adult.
11.130.280 - Appointment and role of court visitor.
11.130.285 - Appointment and role of attorney for adult.
11.130.290 - Professional evaluation.
11.130.295 - Attendance and rights at hearing.
11.130.300 - Confidentiality of records.
11.130.305 - Who may be guardian for adult—Order of priority.
11.130.310 - Order of appointment for guardian.
11.130.315 - Notice of order of appointment—Rights.
11.130.320 - Emergency guardian for adult.
11.130.325 - Duties of guardian for adult.
11.130.330 - Powers of guardian for adult.
11.130.335 - Special limitations on guardian's power.
11.130.345 - Guardian's report—Monitoring of guardianship.
11.130.350 - Removal of guardian for adult—Appointment of successor.
11.130.355 - Termination or modification of guardianship for adult.
11.130.360 - Basis for appointment of conservator.
11.130.365 - Petition for appointment of conservator.
11.130.370 - Notice and hearing for appointment of conservator.
11.130.375 - Order to preserve or apply property while proceeding pending.
11.130.380 - Appointment and role of court visitor.
11.130.385 - Appointment and role of attorney.
11.130.390 - Professional evaluation.
11.130.400 - Attendance and rights at hearing.
11.130.410 - Confidentiality of records.
11.130.415 - Who may be conservator—Order of priority.
11.130.420 - Order of appointment of conservator.
11.130.425 - Notice of order of appointment—Rights.
11.130.430 - Emergency conservator.
11.130.435 - Powers of conservator requiring court approval.
11.130.440 - Petition for order after appointment.
11.130.445 - Bond—Alternative verified receipt.
11.130.500 - Terms and requirements of bond.
11.130.505 - Duties of conservator.
11.130.510 - Conservator's plan.
11.130.515 - Inventory—Records.
11.130.520 - Administrative powers of conservator not requiring court approval.
11.130.525 - Distribution from conservatorship estate.
11.130.530 - Conservator's report and accounting—Monitoring.
11.130.535 - Attempted transfer of property by individual subject to conservatorship.
11.130.540 - Transaction involving conflict of interest.
11.130.545 - Protection of person dealing with conservator.
11.130.547 - Access of conservator to certain assets.
11.130.550 - Death of individual subject to conservatorship.
11.130.555 - Presentation and allowance of claim.
11.130.560 - Personal liability of conservator.
11.130.565 - Removal of conservator—Appointment of successor.
11.130.570 - Termination or modification of conservatorship.
11.130.575 - Transfer for benefit of minor without appointment of conservator.
11.130.580 - Authority for protective arrangement.
11.130.585 - Basis for protective arrangement instead of guardianship for adult.
11.130.590 - Basis for protective arrangement instead of conservatorship for adult or minor.
11.130.595 - Petition for protective arrangement.
11.130.600 - Notice and hearing.
11.130.605 - Appointment and role of court visitor.
11.130.610 - Appointment and role of attorney.
11.130.615 - Professional evaluation.
11.130.620 - Attendance and rights at hearing.
11.130.630 - Confidentiality of records.
11.130.635 - Appointment of special agent.
11.130.645 - Petition for guardianship for minor.
11.130.650 - Petition for guardianship, conservatorship, or protective arrangement.
11.130.655 - Notification of rights for adult subject to guardianship or conservatorship.
11.130.657 - Notification of petition for guardianship or conservatorship.
11.130.660 - Letters of office.
11.130.665 - Guardianship/conservatorship summary.
11.130.670 - Certified professional guardianship board—Grievances.
11.130.710 - Presumption of capacity.
11.130.720 - Authority of supporter.
11.130.730 - Disqualification of supporter.
11.130.735 - Access of supporter to personal information.
11.130.740 - Execution of agreement.
11.130.750 - Reliance on agreement—Limitation of liability.
11.130.755 - Reporting of suspected abuse, abandonment, neglect, exploitation.
11.130.900 - Uniformity of application and construction.
11.130.905 - Relation to electronic signatures in global and national commerce act.