231 Pa. Code r. 1915.21
The order appointing a guardian ad litem in a child custody action pursuant to Rule 1915.11 -2 shall be in substantially the following form:
(Caption)
ORDER OF COURT
AND NOW, THIS_______ day of _______, 20 ____, it is hereby ordered as follows:
Pursuant to Pa.R.civ.P. No. 1915.11-2, is appointed as guardian ad litem for the minor child (D.O.B.) in connection with the civil proceedings related to the custody of the minor child.
The child's guardian ad litem shall represent the best interests of the child. The guardian ad litem shall not act as the child's attorney or represent the child's legal interests.
It is ordered and decreed that all relevant schools, police departments, hospitals and social service agencies including home and school agencies who have records, reports and/or information pertaining to the child relevant to the custody of the child, shall allow the guardian ad litem access to all files and records in its possession, custody or control and shall cooperate in responding to all relevant inquires. These files/records may include but are not limited to medical, psychological or psychiatric charts including evaluations and progress notes and records, X-rays, photographs, tests, test evaluations, intake and discharge summaries, police records, and school records including report cards, educational assessments and educational plans, relevant to this custody dispute and/or relevant to any special needs or requirements of the child. The guardian ad litem shall have the right to copy any part of the files and records maintained in connection with the child.
It is further ordered and decreed that the guardian ad litem shall be permitted to see and speak with the child, and family, medical and/or social service providers connected with this case, and take all steps appropriate to and consonant with this order.
The guardian ad litem shall provide copies of any reports prepared by the guardian ad litem to each party, or to their counsel, and to the court when filed but not later than 20 days prior to a hearing or trial or as otherwise ordered by the court.
The guardian ad litem shall attend all proceedings and be prepared to testify. The guardian ad litem shall be subject to cross-examination in accordance with pa.r.civ.p. 1915.11-2(e)(2) if called to testify.
The fees for the guardian ad litem shall be paid as follows:
______________________________________
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This appointment shall terminate upon the entry of a final order resolving the petition pending as of the date of this order or as provided in subsequent order of court.
BY THE COURT:
_______________ J.
231 Pa. Code r. 1915.21