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HomeMy WebLinkAbout09-05-12 ~ .., Zen ANNUAL REPORT OF ~ . "' ~ ~^ r' c= o f ~ GUARDIAN OF THE PERSON f , ~ s _ ; r J.` , C 8 _ r r ~. COURT OF COMMON PLEAS OF ~ yam,'" N cn m ~o Cumberland COUNTY, PENNSYLVANIA =" ORPHANS' COURT DIVISION Estate of Nicole Hlavac , an Incapacitated Person No. 06-0608 I. Dana and Rose Hlauac was appointed ®Plenary OLimited Guardian of the Person by Decree of J. Oler J. dated 8/31/2006 m A. This is the Annual Report for the period from September 'l 2011 ~ Au~eust 31 2012 (the "Report ]Period"); or ~ B. This is the Final Report for the period from to for the following reason: (the "Report Period', and is filed 1. The death of the Incapacitated Person. Date of death: 2. The Guardianship was terminated by the Court by Decree of dated For a Finn[ Report, omit Sections II through I[ Form G-03 rev. f0 /3.06 Page 1 of 4 Estate of Nicole Hlavac II. PERSONAL DATA Age of the Incapacitated Person: 24 III. LIVING ARRANGEMENTS A. Current address of the Incapacitated Person: 905 Charleston Greene Malvern, PA 19355 B. The Incapacitated Person's residence is: anIncapacitated Person Date of Birth: 06/28/1988 ^ own home / aparknent © nursing home ©boazding home /personal caze home ©Guazdian's home /apartment © hospital or medical facility © relative's home (name, relationship and address) ®other: Group Home C. The Incapacitated Person has been in the present residence since JuIY 10, 2009 If the Incapacitated Person has moved within the past yeaz, state prior residence and reason(s) for move: Form G03 rev. 10.13.06 Page 2 of 4 Estate of Nicole HIavac an Incapacitated Person D. Name and address of dte Incapacitated Person's primary caregiver: Mehnark 2600 Wayland Rd Berwyn, PA 19312 IV. MEDICAL INFORMATION A. The major medical or mental problems of the Incapacitated Person are as follows: Nicole has profound intellectual disabilities including: ADD/ADHD, CP, Autism and OCD due to a rare genetic defect. B. Specify what' if any, social, medical, psychological and support services the Incapacitated Person is receiving: In addition to support services through her group home provider, Nicole is in a vocational program at Mehnark. The program includes supports for Nicole's speech and behavioral needs. V. GITARDIAN'S OPINION A. It is the opinion of the Guazdian of the Person that the guardianship should: m continue ~ be modified ^ be terminated Form G03 ,e,,. io.ti.a~ Page 3 of 4 Estate of Nicole Hlavac , an Incapacitated Person The reasons for the foregoing opinion are: While Nicole is learning self caze and job skills, she remains unable to care for herself and is dependent on others for her care and safety. B. During the past yeaz, the Guazdian of the Person has visited the Incapacitated Person times with the average visit lasting `~ hours, ~ minutes. The report of a social service organizarion employed by the Guardian fo 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 thaz this Vecifrcation is subject to the penalties of 18 Pa. C.S.A. § 4904 relative to uosworn falsification to authorities. 9/1/2012 ~.m~ \~M~ a~~ pole Signmve oJGrmrdmn ojrhe Peron Rose ffiavac xame ojGuardm ojrhe Person (type orp~) 42 Keswick I?r Mechanicsburg, PA 17050 cuy, store, z+y 717-258-5666 TerepMne Form G-n3 „eu. rats.o6 Page 4 of 4 Snpplement to Annual Report of Guardian of the Person Person: Nicole Hlavac; Rocket Nbr: 06-0608 Following are the details regarding visits to Niki during the September 1, 2011 to August 31, 2012 timeframe. Trip # Visit Start Visit End l~utah ou Notes 1 11/23!2011 11/27/2011 91.55 Niki home for'1ltanlcs ~v' 2 12/23/2011 12/26!2011 70.60 Niki home for Christmas 3 04/07/2012 04/07/2012 5.40 Visit Niki for Easter 4 07!06!2012 07/08/2012 48.08 Celebrate Niki's Birthda a bit late 5 08/25/2012 08/25/2012 8.03 Take Niki to Libe Bell and dinner Total visits = 5 Total hours = 223.66 Average Per Visit: 44.73 hrs (44 hours 43.8 minutes)