HomeMy WebLinkAbout09-12-14 .p
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ANNUAL REPORT OF N
GUARDIAN OF THE PERSON C= o J,
M o N o
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COURT OF COMMON PLEAS OF n U' o 0
Cumberland COUNTY,PENNSYLVANIA , °„ 3 -n +
ORPHANS' COURT DIVISION " CO m
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Estate of Gerda Drews an Incapacitated Person
No.21-12-492
I. W1 RODUCTION
Neighborhood Services was appointed
✓❑Plenary0l,imited Guardian of the Person by Decree of J.,
dated 6/12/12
0 A. This is the Annual Report for the period from 6/30/13
to 6/30/14 (the"Report Period 1; or
0✓ 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 IV
Form G03 m.10.13.06 Page I of 4
FlJ�
Estate of Gerda Drews
an Incapacitated Person
IL PERSONAL DATA
Age 94 6/20/1920
g capacitated Person: Date of Birth:
M. LIVING ARRANGEMENTS
A. Current address of the Incapacitated Person:
Golden Living Center, Camp Hill
46 Erford Rd.
Camp Hill, PA
B. The Incapacitated Person's residence is:
F]own home/apartment
0 nursing home
boarding home/personal care home
❑Guardian's home/apartment
hospital or medical facility
relative's home(name,relationship and address)
❑other:
C. The Incapacitated Person has been in the present residence since prior to guardianship
. If the Incapacitated Person has moved within the
past year, state prior residence and reason(s)for move:
Fw G-03 m.. 10.13.06 Page 2 of 4
Estate f Gerda Drews
an Incapacitated Person
D. Name and address of the Incapacitated Person's primary caregiver:
Golden Living Center, Camp Hill
46 Erford Rd.
Camp Hill, PA
IV. MEDICAL INFORMATION
A. The major medical or mental problems of the Incapacitated Person are as follows:
dementia, anxiety, hypertension, ambulatory dysfunction, depression,
osteoarthrosis, hyperlipidemia, UTI
B. Specify what, if any, social,medical,psychological and support services the
Incapacitated Person is receiving:
24 hour skilled nursing care
V. GUARDIAN'S OPINION
A. It is the opinion of the Guardian of the Person that the guardianship should:
❑continue
F-Ibe modified
F]be terminated
Fo G•03 .N.10.13.06 Page 3 of 4
Estate of Gerda Drews an Incapacitated Person
The reasons for the foregoing opinion are:
B. During the past year,the Guardian of the Person has visited the Incapacitated Person
7 times with the average visit lasting hours, 15. minutes.
The report ofa 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 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
relative to unswom falsification to authorities.
8/25/2014 ��� �,
Date S�glntare oJGvardian of the Person
Neighborhood Services
Name ofGvardian of die Person(OW or print)
134 S Prince Street
Address
Lancaster, PA 17608
eio,state.zip
717-392-2175
Telephone
Form G-03 rev.10.13.06 Page 4 of 4