Del. Ch. Ct. R. 175-B

(a) Verification. The petitioner must verify a petition to

enjoin or require healthcare decision-making for a person

(the “Principal”) by another (the “Agent”) under 16 Del. C.

§ 2526. The verification must state that the petitioner

believes the contents to be true under penalty of perjury.

(b) Form. The petition must contain the following

information. If information is unknown, the petition must

state that, represent that the petitioner has made diligent

efforts to obtain the information, and describe those efforts.

(1) Petitioner. The name and address of the petitioner

and the relationship of the petitioner to the Principal

and Agent, or, if not related, the nature of the

petitioner’s interest in the healthcare decision-making.

(2) Principal. The name, age, marital status, domicile,

and current residence of the Principal, as well as:

(A) If the Principal resides in an institution, the

name and address of the institution and the date and

circumstances surrounding the Principal’s

admission;

(B) if the Principal’s expenses are being paid by

another person, the name of the person and the

source of the funds;

(C) if the Principal served in the armed forces of

the United States, the branch and dates of service;

and

(D) if the Principal has been represented by a

Delaware attorney within the past two years, the

name of the attorney.

(3) Agent. The name and address of the Agent, the

relationship of Agent to the Principal, and the source of

the Agent’s authority.

(4) Interested Parties. The names and addresses of

any potentially interested parties, including:

(A) the Principal’s spouse;

(B) any person who would inherit if the Principal

died intestate;

(C) any beneficiary in a testamentary instrument;

(D) any person acting for or named by the

Principal as a fiduciary, including any holder of a

power of attorney or other agent, executor,

administrator, trustee, or person granted authority

under an advance healthcare directive, advance

mental healthcare directive, or other health care

proxy;

(E) any person primarily responsible in the past

six months for the Principal’s care or finances;

(F) any person who contests the petitioner’s

position on contested decision-making; and

(G) if any potentially interested persons are

minors, their approximate ages and their parents,

guardians, or other contact persons.

(5) Agency Documents. The existence and location of

any healthcare document, including any power of

attorney, advance healthcare directive, advance mental

healthcare directive, or other health care proxy.

(6) Estate Documents. The existence and location of

any estate planning document, including any will or

trust.

(7) Nature of Dispute. The nature of the dispute over

healthcare decision-making that is at issue and the

relief sought.

(c) Exhibits. The petition must include the following

exhibits:

(1) a form of preliminary order scheduling the matter

for a hearing and providing for notice;

(2) a form of final order that includes, as applicable,

language discharging any attorney ad litem;

(3) a copy of the document providing the Agent with

authority to act, if there is one, or an affidavit of efforts

to secure same, if unavailable; and

(4) affidavits describing petitioner’s efforts to locate

any interested party for whom contact information is

not provided.

(d) Withdrawal. An attorney who has appeared on

behalf of the petitioner may withdraw by notice if the

petitioner expresses consent by signing the notice.