HomeMy WebLinkAbout01-22-14 COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
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IN RE: CAROLYN KIRK ,AN INCAPACIT�D PEI3�01�,' C�',
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FILLE NO: 21-07-1121 rn � � ^� ��
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ANNUAL REPORT OF THE GUARDIAN OF THE P��E�N �' �' ��'
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l. INTRODUCTION ' --� �°�
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Pennsylvania Guardianship Association / Brian D. Brooks was appointed the
Limited, X Plenary Guardian of the person by Decree of
Or�han's Court , Jud�e Dated: 1/17/08
X (A) This is the Annual Report for the period from 1/17/13 to 1/17/14
_ (B) This the Final Report for the period from
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
, Jud�e, Dated
For Final Report, omit sections II through IV.
2. PERSONAL DATA
Age of the incapacitated person 85 Date of Birth 1/26/28
3. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
GLC BLUE RIDGE 10 HOUSE AVE. CAMP HILL, PA 17011
B. The Incapacitated Person's residence is:
_Ward's own home/apartment
_ Nursing Home
X 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: 2010
If the Incapacitated Person has moved since the last report, state the prior address and reason for
move:
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Estate of: CAROLYN KIRK
D. Name and address of the Incapacitated Person's primary care giver:
GLC BLUE RIDGE PERSONAL CARE HOME
4. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are:
DEMENTIA, HISTORY OF ORAL CANCER, AMBULATION DYSFUNCTION
B. Specify what if any, social, medical, psychological and supportive services the
Incapacitated Person is receiving:
All social, psychological, and medical services are being provided by staff and physicians
at the facility.
5. GUARDIAN'S OPINION
A. It is the opinion of the guardian that the guardianship should:
X Continue Be modified Be terminated
The reason for the foregoing opinion is: The need for guardianship continues.
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.
Date• /
rian . Broo
Pennsylvania Guardianship Association
PO Box 7295
Lancaster,PA 17604
717-299-4568