HomeMy WebLinkAbout01-12-79
~'ffHB.,@9VR." 1 OF COMMON PLEAS OF
'€~J..c.oUNTY, PENNSYLVANIA
Qll1~l:lAiN~t'l.~URT DIVIS ION
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IN REt ETHEL W. BRAND~,
SWORN S'i'ATEMENT OF INSTITUTION PHYSICIAN
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PURSUANT TO 20 Pa~.C.S.A. 5518
Thoma.. P _ Davis, M; D.
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" being4~JY,3~sWdrn according
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to law, deposes~ .and says that he is . a licensed physician
practicing wi,th1\a,hausert VanKir1i'~ .Barton&Davi.s' at
634 Lincolnway East,Chambersb#rgt.Pent1~tlv~nia,that he
is one of the phys:i;;cian~ for t:heLeader Nm:Sihg' Home.,
1070 Stouffer Avenue,Charilbersburgj Pen.~ylvania and that
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from his examfnat;ion' of 'the: alleged i,ncQtnpetent, Ethel W.
Bi'~u(lt, a res'ident,~atsaid in~titution,rep9rts her pr~sent
mental condi tian to be_:~lf foll~~s:
',- 'Ethel W. Bran'dt.spffers from SeVere or~ani~ brainsyndrQme.
She does not ~e~po~d to questioning,givesno indicatiOn of
comprehending;"an~f~ing that is-aaidtoher and the only' thing
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she says is ~J:\;,'.oc:e.8ional"yesn or "noli. She requires constant
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skilled nurslng.care and is of course incompetent and unable to
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make ~ny de~isidns or handle any. of her oW,[}. affa,i.rs~
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111z-lf?-
Date' .
~Ovop~~~? (SEAL)
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Sworn and
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B.SoIIenburoer"JIotarj '-Wit' /~
" ElfPnu MIrth 30, !Hi . . .... . VI. "'.' ..... "
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