HomeMy WebLinkAbout11-27-13 COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: ELI PETROVICH ,AN INCAPACITATED PERSON
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FILLE NO: 21-07-1027 � o 0 0
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ANNUAL REPORT OF THE GUARDIAN OF THE PER$b j m a
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1. INTRODUCTION
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Pennsylvania Guardianship Association / Brian D. Brooks was appginted thp,,, o
Limited, X Plenary Guardian of the person by Decree o?' `o
Orphan's Court , Judge Dated: 12/20/08
(A) This is the Annual Report for the period from
X (B) This the Final Report for the period from 12/20/12 to 10/20/13
and is filed for the following reason:
1. The death of the incapacitated person, Date of Death 10/20/13
2. The guardianship was terminated by the Court by Decree of
, Judge, Dated
For Final Report, omit sections H through IV.
2. PERSONAL DATA
Age of the incapacitated person Date of Birth
3. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
CLAREMONT NURSING HOME 1000 CLAREMONT RD. CARLISLE, PA 17013
B. The Incapacitated Person's residence is:
Ward's own home/apartment
X Nursing Home
Boarding Home/Personal Care Home
Guardians Home/Apartment
Hospital or Medical Facility
_ Relative's Home (name, relationship and address)
C. The Incapacitated Person has lived here since: 2007
If the Incapacitated Person has moved since the last report, state the prior address and reason for
move:
Estate of: ELI PETROVICH
D. Name and address of the Incapacitated Person's primary care giver:
CLAREMONT NURSING HOME
4. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are:
SEVERE DEMENTIA
B. Specify what if any, social, medical, psychological and supportive services the
Incapacitated Person is receiving:
ALL SERVICES PROVIDED BY STAFF AND PHYSICIANS AT THE FACILITY
5. GUARDIAN'S OPINION
A. It is the opinion of the guardian that the guardianship should:
Continue Be modified X Be terminated
The reason for the foregoing opinion is: DEATH OF WARD
B. During the past year the Guardian of the Person has visited the Incapacitated Person
4 With an average visit time lasting 15-20 minutes .
The report of a social service organization employed by the Guardian to 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 true and correct to the best of my knowledge,
information and belief; and that this Verification is subject to the penalties in 18 PA. C.S.A.
S/S 4904.
1�z�" / Date:
Bri D. Brooks
Pennsylvania Guardianship Association
PO Box 7295
Lancaster, PA 17604
717-299-4568