HomeMy WebLinkAbout01-23-15 (2) COURT OF COMMON PLEAS CUMBERLAND COUNTY,
PENNSYLVANIA, ORPHANS-) COURT DIVISION
IN RE: SAMIR E. KHALIL AN INCAPACITATED PERSON
FILE NO: 21-2013-1207
ANNUAL REPORT OF THE GUARDIAN OF THE PERSON
I INTRODUCTION
Pennsylvania Guardianship Association/Brian D. Brooks was appointed the
Limited,X Plenary Guardian of the Person by Decree of
T. Place Judge Dated: 1/03/14
X (A) This is the Annual Report for the period from 12/03/14 to I/Oi�i
(B) This is the Final Report for the period from to 22,
and is filed for the following reason:
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1. The death of the incapacitated person, Date of Death
2. The guardianship was terminated by the Court by Decree of'. co Cn
Judge,Dated
For Final Report,omit sections 11 through IV.
2. PERSONAL DATA
Age of incapacitated person 75 Date of Birth 4/17/39
3. LIVING ARRANGEMENTS
A. Current address of the incapacitated person:
SOUTH MT.NURSING HOME 10058 S. MT. RD SOUTH MOUNTAIN, PA 17261
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 been living there since: 2014
If the incapacitated person has moved since the last report, state the prior address and reason for
move:
Jo
THE ESTATE OF: SAMIR E. KHALIL
D. Name and address of the incapacitated persons primary care giver:
SOUTH MT.NURSING AND REHAB CENTER
4. MEDICAL INFORMATION
A. The major medical or medical problems of the incapacitated person are:
ALZHEIMERS TYPE DEMENTIA WITH PSYCHOSIS,DIOABETES,
HYPERTENSION, BEHAVIORAL DISTURBANCE
B. Specify what if any, social, medical,psychological and supportive services the
incapacitated is receiving: ALL PSYCHOLOGICAL,MEDICAL AND SOCIAL
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:
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 times. 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 the 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/S4904.
Date:
Arr1r"-6-.4rooks
Pennsylvania Guardianship Association
PO Box 7295
Lancaster, PA 1,7604
717-299-4568
Pennsylvania Guardianship Association
PO Box 7295 Lancaster, PA 17604
Ph. (717)-299-4568 / Cell (717)-940-7599 / Fax (717)-299-5540
e-mail pagabrooks(?verizon.net
January 15, 2015
Court of Common Pleas
Cumberland County Court House
1 Court House Square
Carlisle, PA 17013
Attention: Thomas Placey, Judge
Re: Samir E. Khalil No.: 21-2013-1207
Greetings Your Honor,
I enclose the yearly court report of the person for Samir Khalil. I do not include a court
report for the estate. Mr. Khalil has no official ties to the United States. He is not eligible for any
type of income or benefits. He has no known assets to report.
He is receiving the care and management at South Mountain Nursing Home with the total
cost to the citizens of Pennsylvania.
I respectfully ask that any filing fees in this matter be waived. We will continue to
participate in his medical care and management on a Pro Bono basis.
Please feel free call me with any questions, comments or concerns.
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