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AMENDED
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
ORPHANS' COURT DIVISION
In re:
No. 21-06-0177
PATRICIA A. EICHELBERGER,
an incapacitated person ~-.~
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ANNUAL REPORT OF GUARDIAN OF THE PERSON UNDER ';
SECTION 5521(c) OF THE PROBATE, ESTATES AND FIDUCIARIES. ~?~E ,
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For the period: Apri13, 2008 to September 3, 2008.] -,~= =; -~
Part I = --` c~
Status of Guardianship `~
1. I am the plenary guardian of the person of the above-named incapacitated person.
2. I was appointed guardian by Court Order dated April 3, 2006, which has not been
modified by subsequent Orders of Court.
3. This filing constitutes an amended annual report, same from the period April 3, 2008
through and including September 3, 2008.
4. The incapacitated person is deceased. Patricia died on July 31, 2008. Enclosed please
find an original death certificate.
Part II
Living Arrangements
5. The incapacitated person was born on September 28, 1958 and died July 31, 2008 --
age 49 years..
6. The incapacitated person's prior address was Church of God Home, 801 North
Hanover Street, Carlisle, Pennsylvania 17013.
7. The incapacitated person's residence (type of placement) is:
Not Applicable -- Patricia Deceased.
^ His or her own residence
^ Nursing home
^ My home or apartment
^ Relative's home
z
^ Hospital or medical facility O Boarding home
8. The incapacitated person had been living at his or her current residence since
November, 2008.
9. The following is a brief description of the incapacitated person's living arrangements
and the social, medical, psychological, and other support services he or she is receiving: Not
Applicable -- Patricia Deceased.
10. Irate the incapacitated person's living arrangements as: Not Applicable--Patricia
Deceased
^ Excellent
^ Above average
^ Average
^ Below average
11. I believe the incapacitated person is -- Not Applicable --Patricia Deceased.
^ content with the living situation.
^ unhappy with the living situation.
^ unaware of the living situation.
Part III
Physical Condition
12. The current physical condition of the incapacitated person is: Not Applicable-
Patricia Deceased.
^ Excellent ^ Good ^ Fair ^ Poor
13. The incapacitated person's major physical health problems are:
Not Applicable--Patricia Deceased.
14. During the past year, the incapacitated person's physical condition has: Not
Applicable--Patricia Deceased.
O remained the same.
^ improved. [Explain:]
^ worsened. [Explain:]
15. During the past year, the incapacitated person has received the following medical
treatment (including check-ups and dental work):
Da a Ailment Type of Treatment
06/20/08 Pneumonia Hospitalized ICU
Carlisle Regional
Medical Center
07/04/08 ARDS Transferred to Select
Care @ Holy Spirit
07/31/08 Deceased
Part IV
Mental Condition
Doctor's Name
I6. The incapacitated person's current mental condition is: Not Applicable--Fatricia
Deceased.
^ Excellent O Good ^ Fair ^ Poor
17. The incapacitated person's major mental health problems are: Not Applicable--
Patricia Deceased.
18. During the past year, the incapacitated person's mental condition has: Nat Applicable-
-Patricia Deceased.
^ remained the same.
^ improved. [Explain:]
^ worsened. [Explain:]
Part V
Social Condition
19. The incapacitated person's current social condition is:Not Applicable--Patricia
Deceased.
^ Excellent ^ Good ^ Fair ^ Poor
20. During the past year, the incapacitated person's social condition has: Not Applicable--
Patricia Deceased.
^ remained the same.
^ improved. [Explain:]
^ worsened. [Explain:]
21. During the past year, the incapacitated person has participated in the fallowing
activities: Not Applicable-Patricia Deceased.
^ Recreational
^ Educational
^ Social
^ Qccupational
^ No activities available
^ The incapacitated person refuses to participate in any
activities
O The incapacitated person is unable to participate in
any activities
Part VI
Guardianship Activities
22. During the past year, I visited the incapacitated person as follows: approximately 3
times a month. Visited approximately 5 times per week during extended hospitalization.
23. The average amount of time I spent with the incapacitated person on each visit was one
half hour.
24. The last time I visited the incapacitated person was on July 31, 2408.
25. During the past year, I have performed the following activities on behalf of the
incapacitated person: I visited periodically to maintain contact and observe her overall
condition. I attended periodic care plan meetings to assure that the home had a proper
plan in place. I read her quarterly evaluations for assessment of her overall progress. I
observed her condition and commented and requested special care when appropriate. I
oversaw and made decisions on her medical care during her hospitalization.
Part VII
Concerns and Recommendations
26. I ^ do ^ do not (check one) believe the incapacitated person has unmet needs. Not
Applicable--Patricia Deceased.
27. I ^ do ^ do not (check one) have other concerns about the incapacitated person's
physical or mental well-being or finances. Not Applicable--Patricia Deceased.
28. I believe guardianship should be:
O continued without change.
^ modified. [Explain:]
^ terminated. [Explain:]
29. I am the guardian of Patricia A. Eichelberger's estate. My annual report is attached as
well.
I certify that the information contained in this report is true and correct to the best of my
knowledge, information, and belief. This statement is made subject to the penalties of 18 Pa.C.S.
§ 4904 (relating to unsworn falsification to authorities).
obert D. Eic r,
Guardian of Patricia A. Eichelberger
182 Chain Saw Road
Dillsburg, PA 17019
Telephone : 649-7074
September 3, 2008