HomeMy WebLinkAbout04-09-12URT OF COMMON PLEAS CUMBERLAND C UN TY' PENNSYLVANIA
CO ORPHANS' COURT DIVISI
LOUISE CARL , AN INCAPACITATED PERSON
IN RE:
FILLE NO: 2109-0459
ANNUM, REPORT OF THE GUARDIAN OF THE PERSON
1. INTRODUCTION
s lvania Guardianship Association /Brian D. Brooks was appointed the
Penny Guardian of the person by Decree of
_____ Limited, X Plenary
Ju~e_ Dated: 3/30/10
ORPHANS COURT
X
This is the Annual Report for the period from 3/30/11 to 3/30/12
(A)
(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 De Decree of
2. The guardianship was term uat e b Dated o~ by
For Final Report, omit sections II through IV.
2, PERSONAL DATA Date of Birth 2/28/3_7
Age of the incapacitated person 75
3 LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
FOREST PARK NURSING HOME, 700 WALNUT BOTTOM RD., CARLISLE, PA 17013
B. The Incapacitated Person's residence is:
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Wazd's own home /apartment
X Nursing Home
Boazding Home /Personal Care Home
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Guardians Home /Apartment '
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- Hospital or Medical Facility
lationship and address)
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s Home (name, re
Relative
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C. The Incapacitated Person has lived here since: 8/22/08 v rv
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If the Incapacitated Person has moved since the last report, state the prior address and reason for
move:
Estate of: LOUISE CARL
D. Name and address of the Incapacitated Person's primary care giver:
FOREST PARK NURSING HOME
4. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are:
MENTAL RETARDATION, CVA, FAILURE TO THRIVE, CELLULITIS, OSTEOPOROSIS
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.
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. Brooks
Pennsylvania Guardianship Association
PO Boz 7295
Lancaster, PA 17604
717-299-4568
Date• 6