HomeMy WebLinkAbout06-11-13 _ 1�111�
ANNUAL REPORT OF � �; � m
GUARDIAN OF THE PERSON � � z � �
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COURT OF COMMON PLEAS OF � �' � �'" �`µ' ��'�'
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CUMBERLAND COUNTY, PENNSYLVAI�I'`A,:; � rv '�Y ;�
ORPHANS' COURT DIVISION � � cr. +r. ��
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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 Older, Jr. � J.�
dated Apri126, 2010
� A. This is the Annual Report for the period from Apri126 � 2012
to APri126 , 2013 (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 Report, omit Sections II through Ii�
Form G-03 rev. 10.13.06 Page 1 of 4
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Estate of Susan J. Myers , an Incapacitated Person
II. PERSONAL DATA
Age of the Incapacitated Person: 60 Date of Birth: November 15, 1952
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
1004 Havenwood Court, Mechanicsburg, PA 17050
B. The Incapacitated Person's residence is:
❑own home/apartment
❑nursing home
�boarding home /personal care home
0 Guardian's home/apartment
0 hospital or medical facility
❑relative's home (name, relationship and address)
�other:
Townhouse owned by a Special Needs Trust for 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:
Form C-03 rev. 10.13.06 Page 2 of 4
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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, 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:
0 continue
0 be modified
0 be terminated
Form G-03 rev. 10.13.06 Page 3 of 4
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Estate of �t�san J. Myers ,an Inea��ac;itated i'ersc�n
Tl1e x•e�so��s far tlie fai:egQing opinion are:
Ms. Myers rec{tiires sup��ort re��rdii��;}zei•mectieal conclitians,n�edicatians,
i�iteractions with doctors ai�d cleutists a�id ovei•si�ht ofllez� fit�aitces.
13. Dtu�ing the�ast yeai;tl�e Guarciian a£tlie I'ersc�i�l7as visitecl the Inea���icitated Person
36 tin�es tiv'ttl�tlie ave��age visit Iasting �—� hotirs, minutes.
The re��or�t of cr socr��l serttice organiz��tior�e�r�ployeGll�}�tl�e Grtat�drerri to over•see crncl
� con�-clir�ate t/�e c�rP•e of the ��rcapneitrrtecl Per�sor�,fc�r Ilae pe�•iod coverer�1��this Iteport may be
� altached!c�srrpplet�ier�t this Repo►7.
�
1 verify that tile foregoi��� i��for•ination is coi•i•ect ta tl�e best af my kno��Iedge,
infc�rmatioii�nd belief; aYid That this Verification is scibject fa the penalties of 18 Pa. C.S.A. § 49t�4
� relati�re to unsworn f�isificatiaii to ac�t�lorities.
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---;`-_-, / _7�� SfgrrtNnre afGr�nrdfn»ojflre Persorr
D�rlt
Patt•icia A.M. Havetis
,\4mrc ofCt�arcliar�oflke f erswr(type or pr�iitt)
� 1235 C�restfield Drive
���XQSs
W.iiliarns��ol•t, FA 177Q t �
Clty,Sl�rte,"Li�
(570)327-9�7J (h) �
Tele�laate
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