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HomeMy WebLinkAbout07-16-10 (2). ~ I AN UAL REPORT OF GUARDIAN OF THE PERSON © ~~ -r.1 ;; OURT OF COMMON PLEAS OF ~?? ~ ~' - '= 7 UMBERLAND COUNTY, PENNSYLVANIA ~~~ ~ ~ c.~~ ?7 f.~-. ORPAANS' COURT DIVISION ~%cnx °' ~ -'`' "' ~~ ~. ~; c"~ G ~, ~ ~ =~~~ ['7 '~ : s-e`i ~7 N i Estate of ANETTE NEELY an Incapacitated Pe~'son _,,,~ No. 21-08-0032 I. ® Plenary ^ Limited Gual dated March 5, 20Q8 ^ This is the Annual ~ to March 5, ^ B. This ia' the Fhn to , for the for tl~e 1. The de 2. The For a Final Report, omit Stec Form G-03 rev. 10.13.08 anship Services was appointed of the Person by Decree of Edgar B. Ba +3-lev , J., for the period from March 5 2008 2010 (the "Report Period"); or Report for the period from (the "Report Period"), and is filed lowing reason: of the Incapacitated Person. Date of death: was terminated by the Court by Decree of J., dated II through IY. Page 1 of 4 ale ~~ I Estate of an Incapacitated Person II. PERSONAL DATA Age of the Incapacitate Person: III. LIVING ARRANGE A. Current address of, tt Date of Birth: August 22. 1921 Incapacitated Person: Courtyard Gardens Nursing & Rehab Center 999 West Harrisburg Pike Middletown, PA 17057-4801 B. The Incapacitated ~ rson's residence is: ^ own hpme / ~p ment ® nursigg homje ^ boarding horn /personal care home ^ Guard'ian's ho a /apartment ^ hospital or me ical facility ^ relative's hojm (name, relationship and address) ^otiher: C. The Incapacitated,P If the Incap~a~ residence and reasonj(s rson has been in the present residence since 4/1/10 fated Person has moved within the past year, state prior for move: Country M~a ows 451 Sandh'll oad Hershey, P 17033 Ms. Neely requires i~c eased care and assistance with her ADL's, assistance which is not offered at Country Meadow, n assisted living facility. Furor c-os rev. io.is.oe Page 2 0£ 4 Estate of D. Name and address lofl the Incapacitated Person's primary caregiver: III IV. MEDICAL INFbRMA7 A. The major medical c~r an Incapacitated Person Courtyard Gardens Nursing & Rehab Center 999 West Harrisburg Pike Middletown, PA 17057-4801 problems of the Incapacitated Person areas follows: Ms. Neely suffers f>for~ general aging issues, along with Dementia, Hypertension, Hypothyroidism, B. Specify what if an}~, Incapacitated. Person Though Ms. Neely events within Coin Ms. Neely is visite Gardens, for montl Ms. Neely was see Gardens. V. GUARDIAN'S A. It is the opinion of ® continue ^ be modified ^ be terminated ~~I Form G-03 rev. 10.13.06 II Acid Reflux, Hypercholesterol, and Edema medical, psychological and support services the receiving: and encouraged to attend games and all other social Gardens she refuses most of the events. ;e a month by Dr. Nipple, the in house doctor at Courtyard ieck-ups and for any medical issues that may be presented. a Geriatric Psychologist upon her admittance at Courtyard Guardian of the Person that the guardianship should: Page 3 of 4 Estate of The reasons for th~ It is my opinion that she lacks the ment~l B. During the 24-30 1 The report of a coordinate the care of the to supplement this Report. I verify that the for information and beliejf, and relative to unswom f~lsific, Date opinion are: an Incapacitated Person Neely would not be able to exist in any other type of environment, as physical ability to care for herself the Guardian of the Person has visited the Incapacitated Person with the average visit lasting 30 - 90 minutes service organization employed by the Guardian to oversee and ~itated Person for the period covered by this Report may be attached ~g information is correct to the best of my knowledge, this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904 to authorities. ~~ tgnature oJGuardian of the E rate O/ Constance E Stoneroad Name oJCntardian oJthe Estate (type or print) PO Box 804 Address F.lraabethville Pa 17023 City, State, Zip 717-674-5757 Telephone Form G-03 rev. 10.13.06 ~, Page 4 of 4