HomeMy WebLinkAbout06-10-14 o
ANNUAL REPORT OF °
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GUARDIAN OF THE PERSON v o
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COURT OF COMMON PLEAS OF -o -i
CUMBERLAND COUNTY,PENNSYLVANIA ' ry -n
ORPHANS' COURT DIVISION
Estate of Susan J. Myers an Incapacitated Person
No.21-10-0220
I. INTRODUCTION
Patricia A.M. Havens ,was appointed
� Wesley Oler, Jr. J,
0 PlenaryE)Limited Guardian of the Person by Decree of >
dated April 26, 2010
�]✓ A. This is the Annual Report for the P201 ri26 2013
4 from April
to April 26 (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 Flual Report, omit Sections H through IT
FoG43 rev.10.13.06 Page 1 of 4
rm
e of
Susan J. Myers
Estate, an Incapacitated Person
II. PERSONAL DATA
November 15,1962
Age of the Incapacitated Person: 61 Date of Birth:
III. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person.
1004 Havenwood Court, Mechanicsburg,PA 17050
B. The Incapacitated Person's residence is:
D own home/apartment
nursing home
boarding home/personal care home
Cj Guardian's home/apartment
D hospital or medical facility
❑relative's home(name 'relationship and address)
F,71 other:
Townhouse owned by Special Needs Trust for Susan J. My
C, The Incapacitated Person has been in the present residence since
20{ 2
If the Incapacitated Person has moved within the
past year, state prior residence and reason(s)for move:
Form 0.03 10,13.06 Page 2 of 4
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 CrestFietd Drive
Williamsport, PA 17701
(2)Community Treatment Team-Carta Tari more, Director,,114 North Hanover
Street, Carlisle, PA 17013
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the.Ineapacitated Personate as follows:
Schizoaffective Disorder, Diabetes, Hyperlipidemia, Hypertension,
Gastroesphageat Refiux 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)216-1066 per the
attached document
V. GUARDUN°S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
F7 continue
Obe modified
F�be terminated
Fonn G-03 rm 10.13.06 Page 3 of 4
Estate of Susan J. Myers
an Incapacitated Parson
The reasons for the foregoing opinion are:
Ms. Myers requires support regarding her medical conditions, medications,interactions with
doctors and dentists and oversight of her finances.
B. During the past year,the Guardian of the Person has visited the Incapacitated Person
31 times with the average visit lasting � $ hours, minutes.
The report of a social service organization employed by the Guardian to oversee and
coordinate the care of the Incapacitated Person far the period covered by this Report may be
attached to supplement this Report.
I verify that the foregoing information is correct to the best of my knowledge,
information and belief-, and that this Verification is subject to the penalties of 18 Pa. C.S.A. §4904
relafive to unsworn falsification to authorities.
Signature of Cruardion of the Person
Patricia A.M. Havens
Name of Guardian of the Person(type or print)
1235 Grestfield Drive
Atrdrzsr
Williamsport, PA 17701
aCK State,Zip
(570) 327-9079 (h)
Terephane
Form G-03 rev.1A13.Os Page 4 of 4
NHS The Stevens Center: Community Treatment Team - Carlis... Page 1 of 1
NHS The Stevens Center:Community .t.xf_LLt=zi iijf r; p?i!z
Treatment Team t�
Information rltleclual&DavelCumberland t lsab lilies Office Edit Tats ustmu.
The Community.Treatment Team(CTT)Is a sett- ADDRESSES
contained program staffed by mull]-disciplinary staff Who
function Interchangeably as a team to ensure ongoing 114 North Hanover 511`661 I
Individualized treatment,rehabilitation and support Carlisle,PA 17013
Services in the community for Individuals with Severe I V:gm-Mga
r
and persistent mental Illness.An Individual needing
these services can request an Intake and referral by
PHONE NUMBERS
contacting one of the Base Service Units at one of the
following tooailons:NHS:The Stevens Center:
717.243.6033 x225 or x234 Holy Spirit Behavioral (717)210.1066
Health Services;717.763.2219
WEB SITE
Area(s)Served: i
Cumberland,Perry
"`:tp:i;Vnr?%'s_'tsprr{trt}_ig;�ye�r:id.:,�k :nr..
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Eligibility Requirements: n,pt nz`t st 7
Consumer must meet medically necessary criteria for
this level of care. i OTHER TOPICS THAT MAY BE i
USEFUL ;
Record last updated:Jan 17.201310:25AM
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