HomeMy WebLinkAbout04-18-13 �.
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CtJURT UF CUM1VItJN PLEAS CUMBERI..AND CUUNTY,PET�1tiTS'�L'�'AN�IA
ORP�IANS' C4URT DIVISIUN
iN RE: LCtUISE CARL ,AN INCAPACITATED PERSON
FILLE NO►: 21�9-U459
A►��INUAL REPURT lJF THE GUARDIAN+CfF THE PERSt)N
: 1. INTR()DCTCTIC}N
Pennsylvania Guardianship Association/Brian D. Brflc�ks was appointed�the
Limited, � Plenary Guardian of the persan by Decree of
+�}RPH.��tS C4URT , Jud�e Dated: 313 UI 10
X (A} This is the .��nnual Report far the period from 3130112 ta 3/30/13
{B) This the Finai Report for the peric�d from to
and is filed far the following reason:
1. The death of the incapacitated person,D�te af Death
2. The guardianship was tenninat+ed by the Court by L)ecree of
,Jud�e, Dated
Fvr Final Report,omit sections II thraugh IV.
2. PERSONAL DATA
Age of the incapacitated persan 76 I}ate af Birth 2/28/37
3. LNING AIZ]l��NGEMEI�3T5
A. Current address af the Incapacitated Ferson. ,�-�, � �,
FOREST PA,RI�TTURSING H�JI��E, 7Q0�ALNUT BOTTtaM RD.,C�►RLISL�'� 1'701�� � �
vo ..� -� .�,. c�
B. The Incapacitated Person's residence is: r.��.. r.�► � � � �
'V�ard's own hom�/apartment � cz � °° � �
� Nursing Home '� c� :,� ° �
Boarding Home/Personal Care Home � ° � � °� �'�`
. -�.
Guardians Home 1 Aparhnent � ..�`.� � � r�'n
Hospital or Medical Fa�ilit� � � '� ."�
Reiative's Home{name,relationship and address)
C. The Incapacitate�d Person has lived here since. 8l22/�!8
If t1�►e Incapacitated Persan ha�moved since the last report,state the pric�r address and reasan for
mave:
,
�
.,
.
.
Estate of: LOUISE CA►RL
D. Name and a.ddress of the Incapacitated Person's primary care giv�er:
FOREST PARK ATUIZSIhtG HOME
4. 14'IEDICAL I]vFCllt�'VIATION
A. The maj or medical or mental problems of the Incapacitated Ferson are:
: I��IENTAL RETARDATI{JN, CVA,FAILURE TO THR.IVE, CELLULITIS,0►STE+�JPORfJSIS
B. Specify what if any,sacial,me�dical,psycholagical and supportive services the
II1Cc��G1�� P�1'St?ll 1S I�lYlll�:
ALL SERVICES PRC�VIDED BY�TAFF ��NT)1'H'YSICI��15 AT T'HE FACILITY
5. GUA►RDIAN'S�OPII�IICl�T
A. It is the c�pinic�n of the guardian that the guardianship should:
X Continue Be mvdified Be#enminated
The reason far the faregoing opinion is; The need for the guardian continues
B. DU�'lll��'1��5t��'�1�C.�TLli11'C�1�13 Of�1+�P+��SUII�1c�S V1S1���'1�I11Ca.�1�.�{�P#'�'Sfl11
4 �Vith an average visit time lasting 1�-�0 minutes .
The repart of a social service qrgan'�zation employed by the Guardian to oversee and coardinate
the care of the Incapacitated Person for the perio�i covered by t�is Report may be a#tached to
sup►plement this R+�port.
I verify#h;a�the foregoing infvrmation is true and correct ta the l�est����-���-1�+�;�;
infvrffia#i�u�a a�d beli�f;�n� ths#this V�ri�ic�tian is subj�c�to th�p►enaities iu l�P'�. �.�.�..
SlS 4904.
! ��
I�ate. � �
rian D.Brnoks .
Pennsyivania Guardian�hip Ass�ciation
PU Boz 72�5
La��aster,P�i 1?6�4
717-299-4568