HomeMy WebLinkAbout03-15-12 (4)COURT OF COMMON PLEAS CU OURT DIVISION TY, PENNSYLVANIA
ORPHANS
AN INCAPACITATED PERSON TLL~. ~_, ~--~
IN RE: ELI PETROVICH ~ ~o ~_. ,~,_, ,,_,
,.,
~;~n ".
FILLE NO: 21-07-1027 ~? _~ r-- -- `"
~ c_tti ~-
~~`'~
ANNUAL REPORT OF THE GUARDIAN OF THE PERSOl`~ ~ ` ; `-~ --, - 'r.
1~~-n
-,, C ....- . T
1. INTRODUCTION ;~.
a
Pennsylvania Guardianship Association /Brian D. Brooks was appointed the
Limited, X Plenary Guardian of the person by Decree of
Orphan's Court ,Judge Dated: 12/20/08
X (A) This is the Annual Report for the period from 12/20/ 10 to 12/20/ 11
(B) This the Final Report for the period from to
and is filed for the following reason:
1. The death of the incapacitated person, Date of Death
2. The guardianship was terminated by the Court by Decree of
Jude Dated
For Final Report, omit sections II through IV.
2. PERSONAL DATA
Age of the incapacitated person 88 Date of Birth 7/29/23
3. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
CLAREMONT NURSING HOME 1000 CLAREMONT RD. CARLISLE, PA 17013
B. The Incapacitated Person's residence is:
_ Ward's own home /apartment
X Nursing Home
- Boarding Home /Personal Care Home
_ Guardians Home /Apartment
_ Hospital or Medical Facility
Relative's Home (name, relationship and address)
C. The Incapacitated Person has lived here since: 2007
If the Incapacitated Person has moved since the last report, state the prior address and reason for
move:
.~
~~_~
Estate of: ELI PETROVICH
D. Name and address of the Incapacitated Person's primary care giver:
CLAREMONT NURSING HOME
4. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are:
SEVERE DEMENTIA
B. Specify what if any, social, medical, psychological and supportive services the
Incapacitated Person is receiving:
ALL SERVICES PROVIDED BY STAFF AND PHYSICIANS AT THE FACILITY
5. GUARDIAN'S OPINION
A. It is the opinion of the guardian that the guardianship should:
X Continue Be modified Be terminated
The reason for the foregoing opinion is: The need for the guardian continues
B. During the past year the Guardian of the Person has visited the Incapacitated Person
4 With an average visit time lasting 15-20 minutes
The report of a social service organization employed by the Guardian to oversee and coordinate
the care of the Incapacitated Person for the period covered by this Report may be attached to
supplement this Report.
I verify that the foregoing information is true and correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A.
S/S 4904.
Brian D. Brooks
Pennsylvania Guardianship Association
Date• ~ //~
PO Boz 7295
Lancaster, PA 17604
717-299-4568