HomeMy WebLinkAbout02-25-13
IN THE MATTER OF IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
George Edward Snow II, ORPHANS' COURT DIVISION
An Alleged Incompetent
NO. n
C= Cl)
INCAPACITATED PERSON m ~ r
m = n co cn l
;0 P. r rv rr-j 111
PETITION FOR APPOINTMENT r M cn ;Z) t,.J
OF A GUARDIAN OF THE PERSON AND '41
4,
a T'
ESTATE PURSUANT TO 20 PA. C.S.A. 5511 :3
► r7l
1) Your Petitioner is Robert L. O'Brien, Esquire, Solicitor f6T the
Cumberland/Perry County Mental Health/Intellectual & Developmental Disabled Office
(MH/IDD).
2) Respondent is George Edward Snow II, an incapacitated person, currently
receiving care at 5234 Windsor Park Blvd., Mechanicsburg, PA 17055. This facility is
operated as a residential care home for persons with developmental disabilities. Mr.
Snow has been in residence for approximately 15 years. Respondent is an adult
individual being presently 52 years of age with a birth date of August 2, 1960. The
Respondent has a mother, Beverly Ann Justice, age 73 who resides at 15 Powell Lane,
Loysville, PA. Mr. Snow has been in residential care facilities for approximately the
past 37 years.
3) Mr. Snow has never had a formally appointed guardian. His father
George E. Snow, deceased October 24, 2012, had acted as his de facto guardian until
his death. The proposed guardian is Rebecca Wetzel, a case worker with the MH/IDD
office and Mr. Snow's sister. Her current address is 1322 Ridge Road, Liverpool, PA
17045. Ms. Wetzel, through her employment, is familiar with the programs available to
assist Mr. Snow with his life and well being. Ms. Wetzel requests that she be appointed
a guardian to arrange for care for her brother. A determination has been made that,
due to Respondent's low intellectual functioning, he is unable to make determinations in
reference to his placement and care, and that, in order to comply with applicable state
and federal laws, a guardian be appointed by the Court for the purpose of making
determinations as to the care and placement of George Edward Snow II.
4) In summary, Mr. Snow is impacted by Down syndrome which complicates
his intellectual ability and is reflected in assessments that reference his IQ at 30 and his
age related capabilities in the range of a five year old.
5) Mr. Snow's assets and income consist of a small savings account,
controlled by government mandated limits, and a monthly social security benefit.
5) The proposed Guardian has no interest adverse to that of George Edward
Snow II.
WHEREFORE, Petitioner, Robert L. O'Brien, respectfully requests that the Court
order that Respondent George Edward Snow II be adjudged an incapacitated person
and Rebecca Wetzel be appointed Guardian of the Person and Estate.
Respectfully submitted,
Robert L. O'Brien
BY Robert L. O'Brien, Esquire
Solicitor for the Cumberland/CUMBERLAND
County MH/IDD Office
I.D. # 28351
19 West South Street -
Carlisle, Pennsylvania 17013
(717) 249-6873
IN THE MATTER OF IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY, PENNSYLVANIA
George Edward Snow II, ORPHANS' COURT DIVISION
An Alleged Incompetent
NO.
INCAPACITATED PERSON
CONSENT TO APPOINTMENT
I, Rebecca Wetzel, of 1322 Ridge Road, Liverpool, PA 17045, Pennsylvania,
consent to be appointed Plenary Guardian of the Estate and Person of George Edward
Snow II. 1 represent to the Court that I have no interest adverse to my brother, George
Edward Snow II.
/ d
Rebecca Wetzel
VERIFICATION
I verify that the statements made in the foregoing Petition to Adjudicate Incapacity
and Appoint A Guardian of the Person and Estate are true and correct. I understand that
false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904,
relating to unsworn falsification to authorities.
l .
Robert L. O'Brien, Esquire
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.;N5GRO1/c- 5-A F SCHOOL AND P90S I AL
n.
04 >E . .12~i1', iEOT£;e uL~rclrG 'XFR MureT
f.EJ. - 2 I.. ~i
B D_ _ a- ` WARS J a s ~ e a :c_ J. PURPOSE AD]f: 0-23 72. a.; age 12. =x. Cade-' ~,4 - T:r iso:.my,
Adaptive Behavior Cat, ill Cumberland
County 5,S0 166-0-5972.
PREVIOUS AND CURRENT E'V'ALUATIONS
DATE ' TESTS A 14 A 1 Q LEVEL
1 21 72 Uneland 11-5 5,1 SA 44 SQ Moderate-
21 72 PPVT U 2-3 11 Profound
9-5-72 Merrill-Palmer 12-1 2 ; 20 r Sevr.e
e
79-'6 Vineland '__.-l.i b-2 SA 39+ Q Moderate
Because Chip was not in the cottage at the ?iii e, the Sca
in e
was used to provide material for the resident Retiiew, 1It was t Ple Pv
opinion that p is 7a real ti`OGG b s it ...5 _:~:lllo n, that he has
)
lately.
e has 'been attending the school program arranged by the Ii, ue'C_ i u'L e
Unit #16 at Milton and rides the bus daily. 10' had been n on
. a ].ow calc ..e
diet before phag out to ,C:h of lit: tr;,e school ..'a.-ch menu does, riot tau:
uar7.a4.i.onS into rcC )unt,
hG Aides find h 3i helpful- anon. Cor,p>.<a ire He calls t ;era by name.
fie is eat about his clothing hanging lip Pi_S coat when ,':e Comes .i..r., and
always having h.,-s ':a._..r combed, lqe' was -earning to h i:)c.le when this
ex_c'rcise 'was being taugh-'~'
fie 7.kes to help with bathing other, less capable residents. When
there is t1is. oppo 't-an.ity he can use a knife and a Eork at supper. ;.e likes
to carry card game aroLb',.nG with him r.::.CE will S,_t at is table as if playing,
elf.' does not know money val ts. H cannot- tei' t1.me. He taI.KS bl'et
he does not. carry tales. He is active, but is not a show-off.
A review of test scores would suggest o gy-e,1 disparity be-,weeJ;
Soc":ial. Conripete'1n:y and TC~F1Pf2; Oil%111 ability.
P .e pT'°:SP:): SarJ°i_'S
t':'-Le pre~.:di-f i sion estimation of tgen£'.1r9- - self -!,e p s>;ii1s • AS soon a.5 ilia`,,
be, _ tes-G of { Af1~_~t111-50' i should be administered, , and some up-to-ddCe
calculation of so-called mental ability should be made available for
prog:;-arP_ming and goal planning. The direction would weir; to be toward.
COMMUnity p:.aCeMen;. With Which his mother, Wr. r attended the .Review, agretS.
f rt.(~~~~ % J~ fLc h~ S~
- _
Pyac~ella Naflx'er -
Clinical, Psycho-Logist
MM/bs
Daze: 7-15-76 r V 1 1C 1
ILA FSTAAA 2p11 I
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teaching goals. There ha.s so me level of skill regressio :over tl le past yea: and
'.e
conlin ucs To rogi;-ii-e a inoderate level. Oi s-.l)s)or, ZiUMSS ino st adal IN- skill areas, Memory
and his al:iility t•"s perfion i basic acd-vities old daily living app:,ar o be deteriorating,
George works at the Center 41ar I dust. al Training (t IT) lave: days Per week and is ;laid
at training wages.
Goorge is presently fiiriebowng in the n ode.ratc range of develops :enta-i delay
iniellecnual.ly with.moderate tleficiEs in adaptive behavior. This appears to be all accurate
r e~ ection of his current l; vel or skills and abilities- `f'.he cause of Georg-'s clevela3irierital
disability is Jo~ma symdrore, press .tunable caused by " risomy 21. He has additional
medical d' gnoses of hepatitis B (car ier)y ver ous Msuf~iciency, conrpound
by pennyoptic, astiginatisn4 by otliyroi.dlis f, opidc:nia; xeroderma, secondary to glandular
dysfizn:K-tiort' berpe.s S'anplex I, acid cataracts. George has a --nild o it oderate .hearirig
im-pairruent and visual f:inctioiiirig is below normal :inn its. G oxge displays no behaviors
of concern, has nCS psvcliiaE is dii gnc)sis, '-tiff does not tame psyc.l-oactive medicanons. H-
is prese.a ly taping, ~kricept (doiiepezi5 in s., before bed, and ibuP,-ofe_., (dosage
unknown' ir. an effort to help irriprove n".elnor" arid, co gn:itive fundio;^.
~ivai,er.t
--•_zi;; Test , -Score-A-( =c '
_.~xa.ninff
04-04-93 VABS 21 -1.1 C. l✓sl,rl.,
04-04--93 PPV ; -R 40 -l C, Esh.eir131111
[0'05--98 V SS3 S 41 5-4 Team
1008.98 PPVT-3 40 2--2 M. DeWulf
10-08.98 ENT 40 4-6 ✓i. 13;,Wulf
Drs. Feeney and. Eslinge;r at Peti<i State Geisi-nger Hcaitl. System:, Sectiw- of Neurology,
conducted a neuropsychological evalue-ii;in on 9-1-3K, T c Purpose o h evaluatioi: -Was
to deters irle if there was substantial i i&nce of early onset cognitive decline. The
assessment yielded no evidr:iicO of skill regression anal recommejaded repeating
aSSeSS?Tien't5 qerii tliCa ly ai. l Co3A3parIng results to previous scores. Tests adn-iiaistered
iiiclu(, od the BeEiton Teniporal Orientation Test (ls 170 h) and a lexical access test, both of
w laic: yielded sores in the severely impaiNd range,
ti'-IURRR?''t ASSESSIIEN'l
flit E'PA''-. -III is art iridiv : aafly ad.,nii.istered, an.ti.-med., noriri referenced, wide-rx"ge test
av ilnb.li: in two paxallel Torras, Each form contains #'o;ar training itez is and 204 test items -
grouped :into 17 sets ox 12 items cacti. The item sets are a.rrar:ged 1i2. order ok i-i creasing
u•,ifficul.ty Mach itenA c ons Sts of focir black-and-white l-lusts atiens arranged o a page
:
Sen.t 01/11/2013 at 08:38:09 - from - to 7172495755 p5/6
tailed a pictare plate. A he task of the exanii:ae e is to select the; picture that zlest .represents
the niaminof -he word presented orally b, t exvsai e3 . The test se r v,, 6 two Purposes-
?:5 (1) as 3 aci;_feven}.c: t tCA Of recepl ive (bear rig ) vocabulary attalangeIrit for sta ndard
English; and (2) its a scr°eTning test of verbal ab1ty. `Jri!` n1 s scores are as tullows:
Pc, bgd:ti z°:+,tu Vocal,wary Vest - 3
- -
Row Score. - 3,9
Standard Scrrl- _ < 40,
Age F'quivalerr 3°10
Expr ssive. Vocabulary Test
he EW-r is art ind;viduallj- adriiii istered, norm-refere c;ed assesspierl, of expressive
vocabulary ann. word :retneval. It was co--n o_`nied with the PPVT-:3 ar.td 3r casurl-s
Qx ress-ve ocabulary With two type o ;tees, abeling and synonyip. Wo.d :re rievai 3s
cva uated by comparing, expressive and receptive vocabulary skin; usipg standard score
diffei'cn ees between the EV arid P PVT - 1 Georges scores ar- as folliows:
Raw Score 45
Standard Score = < 40
Age p;cuivalcnt = 4-.6
% nch nd Adaptive Behav or Scale
oroaiil Raw Score_Standarc ScuJ_r..AZ4~ Fca va s p!
Coo-,nu,-Acation 3 < 20 4-0
DF. ly Living 97 < 2J .5-4
4ocia ication 89 OR 6--7
Adaptive Behavior Composite: Appt-oxirnately 26 (ExtensiNfe to Pervasive)
P.?vised M'-j3i Mental State Exa., inatien
The N-MOVISE was revised for use with 6-.or u. It contains 6 areas related to orientation,
attention and calculation, -&0, daily living skills, narr±,g, and writing. The reason the
.measure was revised was to eswblish a baselilie level of shill that (leotge was able. to
perform, such that future nwasures can be compared to his curent perfor;na:~.ce n an
C ~ b,r 'to detcixnine if skills are, being lost. ~ ~e orce was able to nn: e the day o f th . w , k,
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the month, count from l to ,let s meth'334 s}secil:ic out of the refrigerator, ~vash and dry
his and s, identi-fy 3 co": rs (blue, greera, grid veflow), iderii7.y a wWch, and copy his narne
ork a piece Of palIer. T,-a-,-,j riemhers will re--adrrii_riister tliis iristrurnerit; designed
sp'-ciftcally for George, every 3-v montl-is and docime.nt t.eir iii-ibigs as one measure of
skill regressior: or the aimerce of regression.
E'UNE:L€7S3ON
George is A an vvith a moderate deve'GDfnental. disability and with limited sapport needs
in, conumamication, daily living, an..d socialization skill areas. Rel;;.tive strcagths are i:i the
social wad daily living skills while rv.tative weaknesses are is the corrmurlication- skJ. I
ai i a kviz..; -,ATitten comiriwucatioa skills}. Res, is o tl:e Most recent .l'l'V•l'-:s anal F Nl'
sUgg€st that GCOI'ge's eXf,'I'essive vocabulary del is ar-, friore f4 fly developed that his
ep'ive skills, Staxidard scot: s on both of these assessments ;~=ere :el 4w 40t he-e is no
di.ect evideirce that early onset cognitive decli3-ie has previously or is preseraly occurriiag.
1. Continil d irnplernental:i-O of Georg e`s current tem., ling l lans with emphasis on
skills priori iZed. by the rtte d:isc-iphr3ary Warn.
2.:~tr•uctured, nmeamngtiil, and. productive. dai,I.y activities consistent -with ;Georgels
preferences, aptitudes and recreat:;sral or leisure :ritemsts.
3, FoachinG of tti CtiOrial werAt, social, afid vLlLatft)3mili CeS'elt?}?3nE;nt s.ki."Is at his
~'c;e•ationfd program. with the goal o t'he traifiing e vant'c:al s'm orted emplrjyrnent,
wage earning; and money iriaria.gemerft.
4. Continued education regwrding diet, nutrition, and exercise Consistent with, is
nmcdical. status and recorn3mmendations !~oro the R.Claistercd Dietii:ian.
5. z'ertfdic 'Wel;.ec;tual., adapieV , 3-0erti811 statazs, reoePtive, aM6 eX--DrC,3ive
languake assess. mei.t to male out early onset cognitive decline..
Michael J. DeWulf. Ph.D. Da c;
Psychologist, Clinical Director
Sent 01/11/2013 at 08:45:31 - from - to 7172495755 p3/4 r
Name. Gacrgc Edward Snow' 11
- Late'. 03/14/112
- - - -
°
Au--- rr•ss: 52'411 Vr:ndsor Boulevftrd, P,lechanicshnrFA 170`;5 - ;
Date o Yirth: G8/02/1960 -
_
its: current Diagnosis' ~ToGeraie Inte -
llectuol/Deveiopmentai 7isabiliiv, Hep
-atitis 3 C'arie.r, DOWn's Syndrome, Jebo.rheic 1)er ititis/Xerodatmu ' '
Fypothyrwdisn,:, HSVl, Gingivitis, Cataracts t)!J, H}roeropia, Dry Fycs, G8i2D, Mode;ate hearing/ iu o
C mi.' speech icss, Jerne t;a, c:aecart}rius, onychomycosis
l fir
I
xy
l sr. rr a~£fteh::;rd~cal history (pza ess mm' hospitaitcaGoas): See attached M°diral 1-".story
- - -
- - - -
- -
Ai ergres ar can?ra rdicated ;edicatiuns: ;list any allergy ?o food, tnedica:rcn or thi; s and list tltz reaction if known, -
i ASP, or NSAMS caused Gi bleed I
Aricepi caused 01 pain, bii,ating tilt: diarrhea - !
iJ rI .t ;
- 10 ~.`•ovm Al!enaes
r
- -
f,urent N edicauocs itacluding PRNs ! t - - 7/.
Dasas e Current A^.dcations inr,!udug PFcNs Dosage
Lcvo :yroxttr 50 me . I at _
- duly _ _ - -
1 Pactcp _axole (portonix) 40 mg t. 'bda --L- -
Tears hiatut<~l Free Sol ! drop :o each eye. twice dai! - - - I
' Y
- -
! tieteccnacoie Si a,-.peo l% apply to h:gad x,:ad neck rinse duty, sho cr - -
- -
I
Ciaensarninc C c nd=oitin 750/60 r 1 tab x d - - _
perio wd (chlorhax tilu) Sol 0.17.%oral ;rose i/2 oz, twice dai;y
- i
-
,tn rruu:vitamin - w - - - -
1 tab da
-
Vaseline lmmmive Care Aloe Lntro_apply tc body ~2 x a d_Y -
-
- - -
i - r -
t eguiar me. t z w rw a uon_ . _
D S•,er:a' Diet Kecunun°nu (list): no sewed :^.etr r~nPS - • ,
i
_
-
m _
l vital in:onrat er. edical personnel need to know in order io pt ovide medical treaonent 'or p?rsot. itnpairmrr.LS wri
i anderstanding or issues with behavior, ete.): vision, hearing, mobility, ~ .
George has dif culty tmdzrstanding sintpJc ins ucticns and spcech is di` icult to i n lerstrnd. 1--is heari❑ lass do s
e. not r !
E s rm t, Zj e .ns pilule}• to heir space"t, in
! :cost situat,oes A ubulwe.5 without difficulty. Shoulld of rave my fn rn ASA or NSA];) coed,cation due to Past Gi bleed Is ~eaatl,ts ~r carrizr and e~
Universal Precautions. Derr:e;lti?, is rrtonitored ann..atly ,v.tl. Mini Wait a, Stat:.s exam and- has lizell stable in the past few years. He has shown less to!crance
when ev en?s do net occur as a expects there to hao en, (du6ny visits at his mothers, changes as work or his church program) and has became upset and angry
more fro e tly, th ~h ;.r, ,t Jttf ant increase ar ho^tc He has not had any difficulty with unperatLrig medical exams o; procedur
es. I !
• ra It h :atrierzrtce ut,crration ;exercise, weigh: r.o;a,-ot, ;zccmmended laboratcrv testiu and/or r; sonai „earth recd -
€ P- t' mtz;endattons): ""i
r1
l
U No :Restrictions or rotor.^.mrndations i
Physical iimi:anoas:
i
"Ifcf?..es ?iciio[,.s or reu-----
-rcpdations
F df~
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Naze: George Snow Datc:03!1d112
Fi°• l.t. `~.'~;X ;Neisrht~~,l 1tF ._~---1.,-J-.L'~- _Tern,^, Yulsc~:-j-°---...._....ResP_._ /j,~%-J _
r-
i t'ileck if : Ormal f3escr;oe if abnnr ma;. If auy a: t n€ exa s, is det'rr: era, indicate to whe if is to he deferred. - - - - -
-
4
Eyes '
L Ears °V y;};' t,,~^✓si: "f s It .r~'F
- '
i
C' Nose
tsJ7 hroat
:
I
r'1 N-c^.k
i Ei i3*easts
- - - '1
l:
j .kart
- - - -
~bdomcn
L1N a.SC iar System
-
.
P'- lasrulosKeietai
:
t
C! n: s
J a1;a i
i 1 G}'nrcoiogicai
-
Anal/ke-;tai
r~
Nervous °v^rem i ! 1 1
- - - - - - - -
i
.',S eFldfS'ldr:ai. is :•UrICn?1}' free 0 arlyrCmlDUnFCatua d;5--'se.
is indivkOual has b en found to have a, communicable rJisezse and the following precautions Should be taken t! prevenr thespread of iafccticn:
Proccgures and h-amunizations Date Results and Recomntendatious
- _r - -
Hepatitis StnPace 3 Antibody 5/84 ~ positive jJ Negative !
- - -
J is aiit1c B irrirrl mly.jons NA 2" i 3" O.ddinnnai Roos,eic Jirpati:is P. car c; - - -
-----v,arrottx stir; Test 3!1R! J 1 Vii] Positiv ~yy NeYa, tive ho 6a con lend e..:•ery 1 ye-,sj Dur.: 2013 -
-
- - - - . - - -
i;hest X-ray Ma-moux TCs. ) NA 1., PcS ave i_) Negative po ba rep aced nn!?• frynarannucj -
Adult l i0i2:!iG (%c becomple,edatleast eveny]Oyears(jrsocner frecn,nm-ended) Due: ;ha:'Cdap2Q;U)
(r.]vcnac illness > 53 years of ale, or as reco»,nte::ded by hvallhcarc provider). D a, age n
Pneumonia Vaccine i U200c
i
- - m - -
No,,nai &Abrr,r;,al Recommend: hearing loss in bosh eaa. RTO vear1Y
1 r C!3il f [ i
t:car L aiuanor
Vision Evalua:.ion 10lt'i 1 Normal X A.bnormal Recommend: cataracts ou; wears grasses. R70 yearly -
- :J
-
-
ammo xaa; i NA Nc-nal I ' Aener^ta; Rcrornmend:
_
Ciynecoicgical 1xam NA ! i`l Nermsi _Abnormai Reccmmerd',_ - -
Prostate ? xam } i I Ii:t dal Abnormal Reroh? rend: J
indicate any additional immU1117atioilS regain 'rtcoutx rended or cw.traindicated forthi.s individual: j
i
' We uired recommend o ct dlcated mmuai
ai - -inns
- - -
of t
t I
Dat
e t
Slg.^.ahre Ham` altncare Frovtdir
✓--•r------
- I
l
Psychological
George Edward "Chip" Snow 2nd D.O.B. 8/2/60 1/21/72
Reason for evaluation:
To facilitate enrollment for institutional placement and
subsequently obtain interim care placement for the patient.
General Observations:
Patient was sitting tailor-fashion in the waiting room looking
casually through magazines. Ile was not about to accompany the
examiner, a stra.n;er, when told he could look at a book in his
office. Chip handed a magazine to the examiner then, conveying
the me ssage that both could remain in the Waiting room and read.
VI(hen accompanied by Mr. Snow, Chip was at! entive, cooperative
for testing of a few minutes duration. Later his father gave
translation for a few phrases Chip used, which related to their
concluding and "going in the car." Ile picked up conversation
about his dental needs once and I understood him to say "teeth."
Tn. three separate instances Chip immediately complied with plain
instruction given by myself and his father. He carried each of
them out for us, i.e. brought examiner a magazine when supposed
to get one from the waiting room for himself instead.
Chip understands social courtesy such as shaking hands, will do
this VIA. t h either hand and repeat the gesture, if cued by verbal
greeting or implicit action. He is very expressive in manner,
though not understood in speech. And affeetiona_te to his-father.
History material indicates Chipt s P.Z.A. 2-4, I.b!.23 at C.A. C-5
Findings of Examination;
Results of Peabody Picture Vocabulary Test Form h indicate Chip, s
A. is 2 years 3 months at this t ime; I.:Z. 11, using extrapolated
norms accompanying the test. A Vineland Social Maturity Scale was
completed, using his f ath.er as the informant. Results indicated
present.:. Age Equivalent of 5.1 and Social Quotient 44, C.A. 11-5
Impression:
Chip seems to function in the Severely retarded range of intelligence
--with the pattern of social functioning over formal intelligence.
He is more than a match for pre-schoolers re practical social skills
and self-helps, eating, bathing, dressing. fie walks well and has
no problems with obstacles, stairs, general balance, climbing. In
an institutional setting with warm sup.F)ort and uidance he would
undoubtedly carry over "helpef 11 and social know-how capability.
czlt
P~ 22~~~~p• SELINSGROVE CENTER
C~ SOCIAL SUMMARY - ANNUAL
DATE: 5-18-79
Name: Cft~~ now Registration No.: 5267
~ySp
.Date of Birth: 8-2-60 Social Security No.: 166-52-5972
Date of Admission: 8-23-72 Type of commitment: Voluntary
County of Responsibility: Cumberland Group Home Level: Intensive Habit
Shaping
Medical Assistance No.: 55-000-9119-J Unit: IV Living Area: Jasper Hall
AAMD Classification: Mental Retardation I.Q.: 39+ SQ M.A.: 6-2 SA
(Moderate) AAMD 31,560 (Down's Syndrome)
Financial competency determination: Not competent.
Financial resources (source and amount) : SSI $25/month
Responsible relative and/or legal guardian: Mrs. Beverly Snow - mother
31 N. Market Street
Telephone: 834-5824 Duncannon, PA 17020
Current Medication: None.
Current Health Status: Good. Overweight, on low calorie diet. Tinea. Pedis - chronic.
Personal Hygiene: Good. Maintains a neat appearance.
Eating: Uses knife, fork and spoon. Has good manners. Uses napkin.
Toileting : Independent.
Dressing: Independent,
Mobility and Gross Motor Development: Good.
Communication Skills: Good receptive skills. Expressive. Uses simple sentences
but is difficult to understand. Is receiving language board
training.
Social Adaptability: Friendly, likeable.
Independent Living Skills Maintains neat appearance. Has all basic self-care:-
skills. Travels grounds independently. Has limited
pedestrian safety skills.
List of Current Programs: Full day intermediate unit school program; community skills
program.
y2 p~~~GR~~p SELINSGROVE CENTER
p y SOCIAL SUMMARY - ANNUAL
DATE: 5-18-79
Name: pC~ 0-4now Registration No.: 5267
~yS
-Date of Birth: 8-2-60 Social Security No.: 166-52-5972
Date of Admission: 8-23-72 Type of commitment: Voluntary
County of Responsibility: Cumberland Group Home Level: Intensive Habit
Medical Assistance No.: 55-000-9119-J Shaping
Unit: IV Living Area : Jasper Hall
AAMD Classification: Mental Retardation I. Q 39+ SQ M.A.: 6-2 SA
(Moderate) AAMD 31.560 (Down's Syndrome) -
Financial competency determination: Not competent.
Financial resources (source and amount) : SSI $25/month
Responsible relative and/or legal guardian: Mrs. Beverly Snow - mother
31 N. Market Street
Tel home: 834-5824 Duncannon, PA 17020
Current Mediation: None.
Current Health Status: Good. Overweight, on low calorie diet. Tinea. Pedis - chronic.
Personal Hygiene: Good. Maintains a neat appearance.
Eating: Uses knife, fork and spoon. Has good manners. Uses napkin.
Toileting : Independent.
Dressing: Independent.
Mobility and Gross Motor Development: Good.
Communication Skills: Good receptive skills. Expressive. Uses simple sentences
but is difficult to understand. Is receiving language board
training.
Social Adaptability: Friendly, likeable.
Independent Living Skills Maintains neat appearance. Has all basic self-care:
skills. Travels grounds independently. Has limited
pedestrian safety skills.
List of Current Programs: Full day intermediate unit school program; community skills
program.
Name George Snow j
Address111 Silver Sprg. R
Mechanicsburg, PA 17055`
Phone (717) 697-7684
Ht. 584" wt. 121 lbs.
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D.O.B. 8-2-60 S.S. No. 166-52-5972
Nearest
Relative Nancv Greenway
Phone (717) 732-1832
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Signatura.