HomeMy WebLinkAbout06-15-12ANNUAL REPORT OF
GUARDIAN OF THE PERSON
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COURT OF COMMON PLEAS OF ~ ~ - ,.~
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Estate of ,Susan J. Myers , an Incapacitated Person
No. 21-10-0220
I. INTRODUCTION
Patricia A.M. Havens ,was appointed
Plenary Limited Guardian of the Person by Decree of J. Wesley Oler, Jr. ~ J•,
dated Apri126, 2010
Q A. This is the Annual Report for the period from Apri126 ~ 2011
to April 26 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
J., dated
For a Final Repo~•t, omit Sectio~as II tlzrorrgh ITS
Fonu G-03 rev. 10.13.x6 Page 1 of 4
Estate of Susan J. Myers
II. PERSONAL DATA
Age of the Incapacitated Person: 59
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person;
an Incapacitated Person
Date of Birth; November 15, 1952
1004 Havenwood Court, Mechanicsburg, PA 17050
B. The Incapacitated Person's residence is:
Q own home /apartment
Q nursing home
Q boarding home /personal care home
® Guardian's home /apartment
hospital or medical facility
[] relative's home (name, relationship and address)
[,~ other:
Townhouse owned by a Special Needs Trust far Susan J. Myers
C. The Incapacitated Person has been in the present residence since 2002
If the Incapacitated Person has moved within the
past year, state prior residence and reason(s) for move:
F'nrn: G-03 rev, 10.13.06 Page 2 of 4
Estate of Susan J. Myers , an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
(1) Guardian -Patricia A.M. Havens, 1235 Crestfield Drive,
Williamsport, PA 17701
(2) Community Treatment Team -Carla Tanzmore, Director, 114 North Hanover
Street, Carlisle, PA 17013
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
Schizoaffective Disorder, Gigantic ventral hernia, Diabetes, Hyperlipidemia,
Hypertension, Gastroesophageal Reflux Disease, Cardiac right bundle branch block,
Obesity, severe Gingivitis, Macular Degeneration
B. Specify what, if any, social, medical, psychological and support services the
Incapacitated Person is receiving:
Cumberland County-
NHS The Stevens Center Community Treatment Team (717) 218-1066) per the
attached document
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
~ continue
Q be modified
be terminated
Form G-03 rev. 10.13.06 Page 3 of 4
Estate of Susan 7. Myers , an Incapacitated Person
The reasons for the foregoing opinion are:
Ms. Myers requires support regarding her medical conditions, medications,
interactions with doctors and dentists and oversight of her finances.
B. During the past year, the Guardian of the Person has visited the Incapacitated Person
30 titnes with the average visit lasting 12--2 _ pouts, minutes.
't'he r•epor•t of a saciai ser•vr`ce ol•galfizutton errrt»cycd by the C,'acardiclrr to o>>elsee and
coor•dtnate the cat•e of the Incapacitated Person for• the period co>>ered by this Report r77cr}r be
a~tac~red to supplerrrent this Report.
I verify that the foregoing information is correct to the best of ttty knowledge,
information anti belief; and that this Verification is subject to the penalties of 1$ Pa. C.S.A. § 4901
relative to uns«JOrn falsification to authorities.
~ %-
Da(s
1'ormU-03 rev. 10,13.06
5fgnaJnre of Grrardrnrr of the Person
Patricia A.M. Havens
Armue of Grrnrdlnn of the Person (J}/~e or prhrf)
1235 Ct•estfield Drive
rfcrdress
Williamsport, PA 17701
CJry, SrnJe, zf~
(570) 327-9079 (H) ___
Telephone
Page 4 of ~4
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