HomeMy WebLinkAbout06-15-07
IN THE COURT OF COMMON PLEAS OF CUMBERLAND CO.,
PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: ANTHONY 1{LIENSTUBER, an incapacitated person FILE NO.06-1089
GUARDIAN OF PERSON FINAL REPORT
[20 Pa. GS.A. 5521(c)]
FROM 1/11/07 TO 6/01/07
1.I am the_Limited X Plenary Guardian of the Person of my ward, named
above.
2. I was appointed Guardian by Order of the Court dated _1111/07 ,which was
X was not modified by Court Order(s) dated
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3. Is the incapacitated person still living? NO _ -~'-,-,,_ c.
If no, answer the following: ~ =~~- ~' ~-- ^~
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(a) Date of Death? 6/01/07 ~ -~ ~~~ "~'~
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(b) Place of Death? ~~'
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WEST SHORE HEALTH & REHAB, CAMP HILL, PA
(c) Name of Administrator or Executor? NONE
(d) Date Guardian of the Person filed the last Annual Report?
THIS IS FIRST AND LAST
4. If the incapacitated person is still living, answer the following questions:
(a) Date Guardian of the Person filed the last Annual Report?
(b) Current address of the incapacitated person
(c) Current age Date of birth of incapacitated person____
(d} The incapacitated person's residence is:
Ward's own residence My home/apartment
Nursing Home Relative's Home
Hospital or Medical Facility Boarding Home
1, ..
(e) The incapacitated person has been living there since
If moved within the past year, state from where and the reason for the
change
(f) I rated his/her living arrangement as:
Excellent Average Below Average
Explain•
(g) I believe he/she is:
content with the living situation
unhappy with the living situation
unaware of the living situation
5. Physical health
(a) Current physical condition of the incapacitated person is:
Excellent Good Fair Poor
(b) His/her major physical health problems are as follows:
(c)During the past year, his/her physical condition has:
remained about the same.
improved Explain
worsened Explain
(d) During the past year, he/she received the following medical treatment
(include check-ups and dental work):
Date Ailment Type of treatment Doctor's name
MONTHLY ONGOING CANE AT FACILITY DR ItASTOGI
HOSPICE ASEI~ACARE
6. Mental Health
(a) The incapacitated person's condition is
Excellent Good Poor
(b) His/her major mental health problems are as follows:
(c) During the past year, his/her mental condition has:
remained about the same.
Improved. Explain
Worsened. Explain
r .,. ~ ~ ..
(d) During the past year, treatment or evaluation by a psychiatrist, psychologist
or social worker ~, was X was not provided. Such mental health
services are briefly described as:
7. Social Activities / Services
(a) His/her current social condition is:
excellent i~good fair ______poor
(b) During the past year, his/her social condition has:
remained about the same.
improved. Explain.
worsened Explain
(c) During the past year he/she has participated in the following activities:
recreational
~educatioaal
social
occupational
no activities available
he/she refuses to participate in any activities
8. Visitation
(a) During the last year, I visited him/her ag follows: QUARTERLY
(b) The average amount of time I spent on each visit was 10-15 MINiTTES
(c) The last time I visited was on 3/0$/07 Date
9. During the last year I have performed the following activities on behalf the
incapacitated person:
ALL MEDICAL AND FINANCIAL DECISIONS
10. I believe he/she has the following unmet needs:- NONE
11. The guardianship Should X should not be continued without
modification because:
DEATH
12. Please note any concerns about the Incapacitated person's physical or mental
well being or the finances that the Court should know.
,'
13. I _X am am not guardian of the incapacitated person's estate. If yes,
my report is attached.
I certify under the penalties of perjury that the information contained in this report
is true and correct to the best of my knowledge, information and belief.
Date:__~L~
atare of the Guardian of the Person
Name: BRIAN D. BROOKS TELE#: 717-299-4568
PENNSYLVANIA GUARDIANSHIP AS50C. INC.
PO BOX 7295
LANCASTER, PA 17604
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