HomeMy WebLinkAbout05-04-12 (2)ANNUAL REPORT OF ~? '='
GUARDIAN OF THE PERSON o
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ORPHANS' COURT DIVISION ~
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Estate of Georgia D. Johnstone , an Incapacitated Person
No. 21-09-00377
I. INTRODUCTION
Gary J. Muccio
was appointed
Plenary Limited Guardian of the Person by Decree of J• Wesley Oler, Jr
dated June 10, 2009
J.,
m A. This is the Annual Report for the period from April 1 ~ 2011
to March 31 2012 (the "Report Period"); or
B. This is the Final Report for the period from
to (the "Report Period"), 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
L, dated
For a Final Report, omit Sections II through Ii!
Form G-03 rev. 10.13.06 Page 1 of 4
Estate of Georgia D. Johnstone
II. PERSONAL DATA
Age of the Incapacitated Person: 75
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
The Oaks @ Bethany Village
5225 Wilson Lane, Room #51
Mechanicsburg, PA 17055
an Incapacitated Person
Date of Birth: Apri16, 1937
B. The Incapacitated Person's residence is:
[~ own home /apartment
nursing home
boarding home /personal care home
Guardian's home /apartment
hospital or medical facility
relative's home (name, relationship and address)
Q other:
C. The Incapacitated Person has been in the present residence since March 22, 2009
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
Form G-03 rev. 10.13.06
Page 2 of 4
Estate of Georgia D. Johnstone , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Gary J. Muccio
6 Derbyshire Drive
Carlisle, PA 17015
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Advanced cognitive dysfunction compatible with primary degenerative process,
likely Alzheimer's disease, history of seizure disorder, hypothyroidism and other
ailments.
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
Services provided by the skilled nursing facility and augmented by private duty
nursing care.
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
continue
be modified
be terminated
Form G-03 rev. 10.13.06
Page 3 of 4
Estate of Georgia D. Johnstone
an Incapacitated Person
The reasons for the foregoing opinion are:
The condition of the incapacitated person has not (and will not) improve.
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
120 times with the average visit lasting hours
25 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 correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties of 18 Pa. C.S.A. § 4904
relative to unsworn falsification to authorities.
Date
Form G-03 rev. 10.13.06
~~ ,
Signature ofGu r ian a Person
Gary J. Muccio
Name of Guardian of the Person (type or prlntJ
6 Derbyshire Drive
Address
Carilsle, PA 17015
Clty, State, Zip
717.385.0507
Telephone
Page 4 of 4